Name:

Age:

Address:

City:

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Zip Code:

How long have you been at this residence?

E-Mail:

Phone:

List name, address, and phone number of your veterinarian:

Name:

Address:

Phone/fax:

1. Are you looking for a male or female?
Male Female Both

Why?

2. What information do you know about the APBT?

3. What restrictions ( BSL {Breed Specific Legislation}), if any, are in your area on the APBT?

4. Are there any children or pets in the houshold? Please list.

5. Are you willing to submit photos of your residence for review of proper enclosures?
Yes No

If no, why?

6. In what type of establishment do you reside in (ex. house, apt, condo etc.)

7. If you rent do they allow the APBT? (If yes please list landlords name and number.)

8. Do you plan on conducting breeding, showing, weight pull, or agility of the purchased puppy? Please explain.

9. If yes to breeding, do you have any knowledge or experience breeding? Why are you interested?Please explain.

10. How will this puppy be housed?

11. Why did you choose this breed?

12. Are you aware of the common illnesses that occur in canines, if not kept current on vaccinations & proper preventatives? If no please state if you would like information included with the purchase of your puppy.

13. Will this puppy be purchased for yourself? Yes No

If no, who will be the primary care giver?

14. Where will this puppy be kept during the day & night?

15. Will this puppy be kept inside or outside? Inside Outside

16. How long will the puppy be left alone?

17. Will you be crate training? Yes No

18. Have you considered an older dog rather than a puppy? Yes No

19. Have you ever purchased a dog from a breeder? Yes No

If yes please list name and number.

20. How long did your last pet live? What were the circumstance(s) of it's death?

21. Have you ever given away, lost, had stolen, including taken to shelter, a pet? If so, what was the circumstances?

22. What activity level do you expect of your purchased puppy?
Very High High Moderate Low Couch Potato

23. Will you be doing any training? Will you be doing the training?

24. Please list 3 references. Include name, number and e-mail address.

25. List any other comments you may want to add:

Thank you for your time! You will be contacted shortly.