Name:
Address:
City:State: Zip:
Home Phone:Work Phone:
Cell Phone: E-Mail:
Occupation:
1. Do you own or rent your home?
2. How long have you lived at this address?
3. How large is your yard/or how many acres?
4. Name and phone number of neighbor:
5. Do you have a fenced yard?
6. If so, what type of fencing?
7. If you do not have fencing, how will you handle the puppy’s exercise and toilet
duties?
8. How many adults and children in household?
9. Ages of children?
10. Do you own other dogs?
11. If yes, list the breed, sex, and age:
12. If you own other dog(s) are they neutered or spayed?
13. If you own cats are they declawed?
14. If you own a dog(s) and/or cat(s) please give the name, address, and phone
number of your veterinarian:
15. Do you have any experience in training a dog?
16. Have you owned an Australian Shepherd before?
17. Why did you choose this breed?
18. What is your color preference?
19. Do you want a male or female?
20. How many dogs have you owned in the last 10 years?
21. If you have owned dogs in the last 10 years that are not presently living with you,
what happened to them? Be specific.
22. Will the puppy live in the house?
23. If you work, how and where will the puppy spend its days?
24. Where will the puppy spend the night?
25. How many hours on the average will the dog spend alone per day?
26. List all plans for this dog: Pet, Guard, Herding, Obedience, Breeding,
Conformation, Agility, Other:
27. Please add any additional comments you would like to make:
Note: All puppies not sold as Show/Breeding quality will be sold with Spay/Neuter
contracts.