Client Questionnaire

Please complete this form and click the Submit button when you are ready to send the information.

Name:

Email Address:

Street Address 1:

Street Address 2:

City: State: Zip Code:

Phone (home):
Phone (work):
Phone (cell):

Fax:

Good time to call if we need to reach you:

How did you hear about us?

Internet Search Engine
Dogs USA Magazine Picture Ad
Puppies USA Magazine Picture Ad
Dog Fancy Magazine Classified Ad
Dog World Magazine Classified Ad
Total Rottweiler Magazine Ad
Referral from Previous Client
Other (please list source):

What age dog are you interested in obtaining?
Puppy
Young adult
Mature adult

What sex dog are you interested in obtaining?
Male
Female
Either

List any conformation and/or working titles that your dogs have earned in the past:

What activities will you and your dog be involved in? (check all that apply)
Companion/Pet
Show
Obedience
Schutzhund
Breeding
Agility
Herding
Carting
Weight-pulling
Tracking
Guarding

Have you ever owned a Rottweiler?
Yes No

 

If you answered "Yes" to the above question how long have you owned your Rottweiler(s)?

 

Where will the dog live?

 

Tell us about yourself. Include occupation, family status, hobbies, etc...

 

Describe your idea of the "IDEAL" Rottweiler for you. Is there any quality you don't want in your dog?

 

Do you presently belong to any dog clubs? If so, list them. 
(If you belong to more then 8 then list the rest of them in the last box and separate the clubs using a comma and space)

 

Do you have any children living in your home? If so, list their ages:
Child One: Child Two: Child Three: Child Four:
Child Five: Child Six: Child Seven: Child Eight:

 

Do you currently have any pets? If so, please the type of pets you have including their age and sex.
(If you have more then 6 pets then list the rest of them in the last box and separate them using a comma and space)

 

Have you completely and thoroughly read and are you willing to comply with our Sales Policy and Contracts?
Yes 
No

 

All show/breeding prospects must be two years of age and have an OFA number before breeding is allowed. Are you willing to do prelim x-rays at 12 months and offical OFA x-rays at 24 months?
Yes
No

 

Your Age:

 

Where will the dog stay during the day?    
Where will the dog stay during the night?    

 

What type of area do you live in?
Urban
Suburban 
Rural

 

Do you own or rent?
Own
Rent

 

Do you live in a house or apartment?
House
Apartment
Trailer

 

Will the dog live indoor or outdoor?
Indoor
Outdoor

 

Do you have a fenced in yard?
Yes
No

 

Have you checked into any breed/training clubs in your area?
Yes
No

 

From which of our female(s) are you interested in obtaining a puppy?

 

Have we spoken on the telephone? If so, what were the details of our conversation?

 

Please give us any additional information that might help us make our decision.

If you can see the box below, do not put anything in it or the form will not be sent!

 

We reserve the right to turn down any home 
not deemed suitable for our puppies.

We would like to thank you for taking a moment to fill out this questionnaire.

       

Be Patient after clicking the submit button. This is a large form a may take some time to be sent.