Puppy Application "*" indicates required fields Contact InformationFirst Name* Last Name* 2nd Contact Person Street Address* City* State* Zip Code*Home Phone*Work or Cell Phone*Email Address* InterviewHave You Ever Owned a Dog Before?* Yes No If Yes, What Breed?* What Other Animals Live in Your House?* What Is the Most Important Reason(S) for Purchasing a Samoyed? (Check All That Apply) Family Companion Show Dog Obedience Companion Breeding A Dog for the Kids Pet Therapy Agility / Fly Ball Competition Other If other, please specify Do You Prefer a Male or Female Puppy/dog?* Male Female Family ProfileWhat Is Your Marital Status / Living Arrangement? (Choose Best Fit) Married Single Separated Widowed Live with Parent/Relative Property ProfileWhat Type of Area Do You Live in?* City Suburb Subdivision Country Is Your Yard Fenced?* Yes No If You Do Not Have a Fenced Yard, Where & How Will the Dog Be Exercised & Be Allowed to Eliminate?* Fence Type? Fence Height? Do You Have a Deck?* Yes No Is There a Railing? Yes No ArrangementsWill the Puppy/Dog Be Kept:* Inside Outside In Yard Loose Kennel Run Garage Basement Other If Other, Explain Where Will the Puppy/Dog Sleep at Night? Where Will the Puppy/dog Be Kept When No One Is at Home? Additional InformationPlease Add Other Information That Would Be Helpful in Placing a Puppy With You CommentsThis field is for validation purposes and should be left unchanged.
