Preliminary Placement Questionnaire

Please provide us with your contact information.

Name:
Street Address:
City:
State:			Zip:
Phone:
E-mail:
Have you ever owned a dog:	Yes No		Dalmatian:	Yes No
When do you want a dog:	Immediately Within 3 mos Within 1 yr --		I'm interesed in:	Puppy Adult Any --
I want the dog for:	Show Breeding Pet Security Racing		The dog will live:	Inside with family Inside a kennel Outside

Other questions or comments