Date:_________________

PLEASE ANSWER THE FOLLOWING QUESTIONS SO THAT WE CAN MORE EASILY TEST AND SELECT THE RIGHT PUPPY FOR YOU.

Name:_________________________________________________________________

Address:________________________________________________________________

City, State and Zip:______________________________________________________

Phone Number (Home)______________________ (Work)________________________

Good time to call: _________________________________________________________

How were you referred to us?_______________________________________________

Are you interested in a Male___________________ Female________________________

What color are you interested in?_____________________________________________

Why are you interested in obtaining an Australian Shepherd?________________________

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Why are you interested in obtaining one of our Aussies?

Companion____________ Show Breeding____________ Obedience Ring____________

Agility________________ Frisbee Comparison________________

What qualities do you like in an Aussie?________________________________________

What don’t you want in an Aussies?___________________________________________

Is This your first Aussie?________ Previously owned dogs_________________________

Have you examined our sales Policy?________ Are you committed to caring for this dog

for it’s lifetime?__________________________

Have you ever had to euthananize a dog?______ If so why?__________________________

Are you willing to spay/neuter this dog?__________ If not Why?____________________

If you are considering breeding, do you promise to have this dog x-rayed for dysplasia and

consult us prior to breeding?______________________________________________

Family Data: Married_________ Single_____________ Divorced_________________

Occupation of adults in family:____________________________________________

others in household that have contact with the dog:______________________________

Where will the dog stay during the day?______________________________________

Where will the dog stay during the evening?:____________________________________

Do you live in: Urban:_______ Suburban:__________ Rural:______________________

Environment/ Own Home or Apt.____________________________________________

Further information about your self and family:___________________________________

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How much research have you done on Australian Shepherds?______________________

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Are you willing to take formal obedience classes with a qualified trainer?____________

Please list the names, address and phone numbers of 3 references.( One must be from your veterinarian ).

1. Veterinarian._____________________________________________________________

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2._________________________________________________________________________

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3.__________________________________________________________________________

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