Name:


Address:


City:


State:


Zip:


Home Phone:


Work Phone:


Email:


Occupation:


Own/Rent:


Lived At Address (number of years):


Acres:


Fenced Yard:


Type Fencing:


Adults/Children:


Children Ages:


Own Dogs:


Breed/Age/Sex:


Neutered/Spayed:


Why Choose This Breed:


Owned Before:


How Many:


Reside In House:


Spend Days:


Spend Nights:


Average Hours Alone a Day:


If No Fencing, Exercise/Toilet Duties:


Veterinarian:


Number of Dogs Owned in Last Ten Years:


Plans for Dog:


Comments:

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