form

Our EMAIL

All people interested in purchasing a dog from North Wind Pekingese “MUST” complete the following questionnaire.

Name:
Email Address:
Address
City
State
Zip
Have you ever owned a Pekingese?	YES
	No
If so when?
Do you still have the Pekingese?
If no, why not:
If you are thinking of purchasing a Pekingese puppy, will it be for:	You and your family
	A friend
How many people are in your family:
Adults
Children
Please explain, in your own words, what prompted you to think of owning a Pekingese puppy:
Would you consider spaying or neutering your puppy	Yes
	No
If no, why not:
Please provide 2 references as to character and ability to provide a stable and loving home for the puppy:
Your Home Phone
Name of Reference #1
Phone #2
Please provide the name of your veterinarian:
Phone

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