*Name:
Street
Address:
City
State:
Zip Code:
Phone:
What kind of vehicle do you
drive
*Email:
Number
of People in the household
1 2 3 4 5 6 7 8 9 10+
Do you
have a Fenced Yard?
Yes No
If you
do not have a fenced yard how do you plan to exercise
your puppy?
Please
describe the environment in which the puppy will live.
Yes No
Yes No
Yes No
Yes No
Do you
plan to breed?
Yes No
Do you
prefer Male or Female?
Male
Female
Please explain preference:
If we do not have your
preference would you take either sex?
Yes No
Do you want a
Show/Breeding Potential puppy?
Yes No
Do you want a pet
puppy?
Yes No
If we do not have your
preference of pet or show would you take the
other?
Yes No
Would you be
interested in showing if we sold you a show
pup?
Yes No
What kind of
personality are you looking for in your puppy?
How do you plan to
train/socialize your puppy? (puppy
kindergarten/obedience and house train act.)
Please list name,
address and phone number of your veterinarian and also
personal references.
Owner input is critical
if a breeder is to keep track of the quality of his
breeding program. Would you be willing to keep in
contact with us?
Yes No
Finally is there
anything else you would like us to know for our review
of your questionnaire?
* To prevent spamming of our form please enter the characters you see in the image below, then click Send:
Questionnaire For
Prospective Puppy Buyers 
