Please complete and return the following application/questionnaire with $200.00 deposit. Your answers will enable me to fully understand your requirements and desires in a Golden Retriever and determine the suitability of your home to an individual puppy.
Acceptance of this application does not guarantee that you will be selected as a home for a puppy. If no suitable puppy/breeding is available your deposit will be returned.

GOLDEN RETRIEVER PURCHASE APPLICATION/QUESTIONNAIRE

Name

E-Mail Address:

Address:

City: State: Zip:

Telephone -Evening:                                          Daytime:                               Fax:

Is the above address a Single Family Home or an Apartment or OTHER (explain)

Number of Adults living at home:

Number of children living at home? _____ (if none skip to next question)

Name, sex and age of each child living at home:

What energy level best describes your home atmosphere?

Occupation of Husband:

Occupation of Wife:

Have you owned a dog before? Yes No

If YES please state Breed, Age, Size, Sex, Neutered/Spayed/Intact


If Intact, how many litters have you bred or has your male sired?
(Were the puppies sold to show homes, obedience/hunting/performance or on Limited Registration as pets.)

Are the dog/s still living with you? Yes No

If NO please explain.

Are there other pets in the household, if so please specify.

Why do you wish to purchase a puppy at this time?

Do you want a Male or Female puppy and why?


Please check primary reason for purchasing this puppy and circle additional activities intended.

Family Pet Pet and Obedience Competition Pet and Hunting Show Only

Show and Obedience Show and Hunting Show/Obedience/Hunting Stud dog Brood bitch

Agility Trials Tracking
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Have you shown a dog competitively? Yes No

If YES in what areas of competition?
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Do you have a Yard? Large Medium Small

Is the Yard completely fenced? Yes No Dog area only

Do you have a Pool? Yes No

If YES is the Pool fenced and Puppy/Dog Proof? Yes No

Where will the Puppy/Dog get most of his/her exercise?

Where will the Puppy/Dog stay during the Day?:

Where will the Puppy/Dog stay at Night?:

Where will the Puppy/Dog stay when left alone?:

Where will the Puppy/Dog sleep?

Where will the Puppy/Dog eat?

Will the Puppy/Dog Travel with you on any trips or vacations?

Where will the Puppy/Dog stay if you are gone for an extended vacation?

Do you intend to crate train the Puppy/Dog?

Is there an Adult member of the household at home all day?

If No* please give number of hours that the puppy would be alone each day.

If No* who would be the first member of the family to arrive home?

Who will be taking the puppy/adult to puppy classes and obedience school?

Will you be consulting a veterinarian for the full series of puppy shots and annual examinations.
If No Please Explain

Do you already have a relationship with a veterinarian?

If YES please list the veterinarian¹s name, address and phone number:

Our 'companion pet' puppies are NOT sold for breeding purposes. Do you agree to either neuter or spay your 'pet' puppy at the appropriate age? YES NO

Please tell us how you heard of us?

Any further information you would like to add!