| Name 
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 | Email 
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 | Home Phone 
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 | Cell Phone 
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 | Work Phone 
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 | Address 
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 | City 
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 | State 
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 | Zip 
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 | You live in 
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 | Do you have a pool or spa 
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 | Is it protected 
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 | What size property do you have 
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 | Do you have a yard 
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 | What is your yard size 
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 | Is it fully fenced 
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 | Fence height 
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 | You work from 
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 | Occupation 
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 | Do you have children 
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 | If yes, how old are they 
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 | Do you have any dogs now 
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 | What breeds 
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 | How many dogs do you have 
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 | Are they neutered or spayed 
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 | If no, are there plans to 
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 | Do you have other pets 
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 | Have you had dogs before 
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 | What breed 
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 | When 
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 | Did you have any problems 
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 | Do you plan to breed 
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 | Have you bred dogs before 
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 | Why do you want a dog 
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 | What breed are you looking for 
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 | Why do you want that breed 
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 | Please describe your ideal dog 
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 | Where will the dog be daily 
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 | Where will the dog sleep 
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 | How long will the dog be alone 
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 | How will the dog get exercise 
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 | What activities do you enjoy 
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 | When did you want to get a dog 
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 | Do you want a Pet or Show dog 
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 | Do you want a male or female 
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 | How Strong is your choice 
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 | What age dog do you want 
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 | How Strong is your preference 
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 | Please list Veterinarian References 
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 | Please list Personal References 
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 | How did you find us 
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 | Comments 
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