Today's Date:
Your Name and Age:
*Spouse, Roommate, partners name (s) & age(s):
Your Occupation: full time or part time?
Full Address: (P.O Box not acceptable)
*Home Number:
Cell Number:
Work Number:
Breed(s) of dog(s) you are interested in?
Age of dog(s) you are interested in?
Are your current animal(s) allowed on the furniture? If no, why?
Does your current animal(s) get along with other animal(s)? If not, please list what animal(s) and explain the circumstances.
How will you exercise your new dog(s)? How often? Where?
Do you have a fenced in yard? If so, what type and what height?