*Your Name
* Email Address
* Address
* City
Do you own or rent?
Rent
Own
* Do you have a yard?
No
Yes
* If so is the yard fenced?
Yes
No
* How many hours in the day will the puppy/dog be left home  alone?
How many people under the age of 12 live in the household?
How many people over the age of 12 live in the household?
What is the primary caregiver's occupation?
High School/College
Student
Employed Part Time
Employed Full Time
Full time
homemaker/retired
What type of puppy/adult are you looking for?
Pet Puppy
Pet Adult
Show Puppy/Adult
Do you have a gender preference?
Female
Male
Either
Do you own any other pets?
Yes
No
If so what other pets do you have?
*  Please provide name and phone
contact information for 3 references.  
These are required fields
*  Your Phone
Number
  Thank you for filling out our puppy questionaire.  We will
be in touch very shortly.   Please be advised our puppy
prices start at 1800.00. We live on the west coast of
Canada on Vancouver Island and prefer not to ship.