General Information

Today's Date   

Your Name     

Spouse's Name   

Address   

City       State/Prov.      Zip   

Country   

Phone    [Home]        [Work]

Email   

Personal Information

How many children living at home?      

Names and ages of children living at home?  
   

Will your Bouvier be a house pet?           or a yard pet?  

Do you have a fenced in yard?  Yes      No

If no fenced yard, explain how and where you will allow the dog to exercise and relieve itself.
   

Do you have other pets at this time?  Yes      No

If yes, are they spayed or neutered?  Yes      No      Some Are

Please describe these pets, including gender.
   

What time of day is best for us to call you?
   

How did you find us?  Did someone refer you to us?  Who?
   

Puppy Information

Do you want a   ~~   Puppy      Adult ?     Either Puppy or an Adult

Male      Female      No Preference ?

Do you want a Bouvier for   ~~   Companion      Show      Obedience      Herding      Agility

Do you have a color preference   ~~   Yes      No       Color  [black, grey, brindle, fawn]

Are you willing to take your Bouvier to Obedience Classes?  Yes      No

Have you owned a Bouvier?  Yes      No    How many?    How Long yrs.

If yes, where did you get your Bouvier(s)?  
   

Where will your Bouvier be kept during the day?  night?  when you're not at home?
   

When are you looking to purchase a puppy?
   

What qualities do you like in the Bouvier des Flandres?
   

What are your concerns about owning a Bouvier?
   

What else would you like to share about yourself, your family, and/or your pets.
   

Name, address, and phone number of your veterinarian.  Other references?
   

Thank you!

We appreciate you taking time to answer these questions.