Inquery Form

1. Contact Information

Name:
Street Address:
City, State, Zip:
Home Phone:
Mobile Phone:
Office Phone:
E-Mail Address:

2. Pet History (Last 10 Years)

Type/Breed:
Sex: Male Female
Age:
Spayed/Neutered: Yes No
Still with you?: Yes No
Why?/Why Not?:

2. Pet History (Last 10 Years)

If you have had a bichon before, whom did you purchase it from?

2. Pet History (Last 10 Years)

Individuals in the Household (list Ages for Children)

2. Pet History (Last 10 Years)

Type of Residence:
House
Condo
Mobile Home
Apartment
Other

2. Pet History (Last 10 Years)

Do you:
Own
Rent
Live with Parents
Other

2. Pet History (Last 10 Years)

Do you have a fenced yard?
Yes No

2. Pet History (Last 10 Years)

Do YOU have any experience with keeping up a coated breed? Please describe...

2. Pet History (Last 10 Years)

Whose responsibility will it be to care for the puppy?

2. Pet History (Last 10 Years)

Where will the puppy be kept?

2. Pet History (Last 10 Years)

What are the occupations/average work hours for you and your spouse/partner?

2. Pet History (Last 10 Years)

Who will care for the puppy during times when you are away?

2. Pet History (Last 10 Years)

How many hours a day will be puppy be left alone?

2. Pet History (Last 10 Years)

Where will your puppy sleep at night?

2. Pet History (Last 10 Years)

Have you ever trained an animal before? Please explain...

2. Pet History (Last 10 Years)

Describe your feelings about disciplining and training your dog? What are your plans in this regard?

2. Pet History (Last 10 Years)

Are you familiar with crate training?
Yes No

2. Pet History (Last 10 Years)

To what extent do you use crates?

2. Pet History (Last 10 Years)

Do you plan to do:
Obedience Training
Agility
Conformation/Showing
Therapy Work
All listed
Other Activity

2. Pet History (Last 10 Years)

How much do you think it will cost to care for, groom, vaccinate and license your bichon each year?

2. Pet History (Last 10 Years)

Are you willing to take responsibility for this dog for the rest of it's life? Explain.

2. Pet History (Last 10 Years)

Are you willing to feed a high quality food even if it costs more?
Yes No

3. Miscellaneous Information:

How did you come to know of the bichon breed?

3. Miscellaneous Information:

Do you plan to Show your bichon?
Yes No

3. Miscellaneous Information:

Do you plan to Breed your bichon?
Yes No

3. Miscellaneous Information:

If necessary, would you agree to have your dogs biopsied when it reaches 1 year of age?
Yes No

3. Miscellaneous Information:

Would you agree to respond to any health questions your breeder might need answered for her records?
Yes No

3. Miscellaneous Information:

Would you agree to return this dog to me, its breeder, if for any reason you cannot keep it?
Yes No

3. Miscellaneous Information:

Please indicate your gender preferences.
Male Only Female Only
Prefer Male, but would take Female
Prefer Female but would take Male

3. Miscellaneous Information:

When would you like to purchase a puppy?

3. Miscellaneous Information:

Please type the name, address and phone number of your veterinarian in the box below.

3. Miscellaneous Information:

Please include any other comments, questions, information that you would like to include in this application in the box below...

3. Miscellaneous Information:

NOTE: Your typed name and date in the boxes below will be considered equivalent to your written signature once you submit this form. It signifies that you have read all of the information on this form and the answers you have provided are truthful. It also signifies that you are looking to purchase a puppy for yourself and not to resell.

3. Miscellaneous Information:

NOTE: All input fields are REQUIRED. Before clicking on SUBMIT please check if you've missed any.

3. Submit application:

Signed By:

Date: