Name
Home phone number:
Cell phone number:
Address: (Street, city, postal code)
Email address:
Your age:
Ages of others living in your home:
Location:
Do you have a secure fenced yard?
Who will be the primary caregiver:
Where will the puppy be kept during the night:
Where will the puppy be kept during the day:
Is anyone home during the day?
Average number of hours the puppy will be left alone:
Who will feed and exercise the puppy during the day:
Are you interested in:
Tail style - Do you prefer:
Will this be your first Black Russian Terrier?
Previously owned breeds:
What animals are living in your home now:
Are you committed to caring for the dog for life?
How long did your last pet live:
What were the circumstances of it's death?
Have you ever returned a pet to it's breeder - if so why?
Have you ever given a pet away - if so why?
Why are you interested in a Black Russian Terrier?
Do you want a dog for:
When would you like to get a puppy?
Briefly explain why you have chosen this time to bring a new dog into the family:
Who will be responsible for brushing and grooming?
Have you ever had to euthanize a dog - if so why?
Do you have any special concerns about Black Russian Terriers?
How did you hear about us?
Are you willing to keep us informed of the puppies progress with regular updates and photos?
Date:
Your name printed here is your signature:
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