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                                                                                                        Premier Danes
                                                                                          APPLICATION FOR PURCHASE
 
Date:_________________
Please fill out and return to:
                    
Jill Stout
4860 S. San Paulo Ave.
Sierra Vista, AZ. 85650. 520-335-1982
premierdanes@gmail.com

Applicant Information
Name: __________________________________________________________________________
 
Address: _________________________________________________________________________

City:  ____________________________________________________________________________

State: ____________________________________________________________________________
 
Zip:  ______________________________________________________________________________

Telephone: Home:  ___________________________________________________________________

Employer: _____________________________________________________________________

Work Phone: _______________________________________________________________________

Cell:  ______________________________________________________________________________

E-mail Address:______________________________________________________________________

Date of Birth:  _______________________________________________________________________

Number of People in Household:_________________________________________________________

Social Security #  _____________________________________________________________________                    

Co-Applicant Information:
Name:  ______________________________________________________________________________

Relationship:______________________________ Soc Sec # ___________________________________

Phone: _______________________________________________________________________________

Work: ________________________________________________________________________________
 
Work Phone: ___________________________________________________________________________   

E-mail Address: _________________________________________________________________________

Date of Birth:  ___________________________________________________________________________

General Information
Type of residence:      House             Apartment             Town-home/Condo                       Mobile Home             Farm
 
Do you own or rent? __________________________

If rental, are dogs allowed? 
      Yes                No                   Maybe
Size Restrictions?       Yes         No                                            
Max. Size:

If Renting, Landlord Contact Information: Name: ________________________________________________________________

Phone number:__________________________________________________________________________________________
 

Where will dog live?       Inside only                  Outside only                    Both                  Inside(%)                       Outside(%)

Where will the dog spend nights?            Family Member’s Bed               Dog Bed                Garage             Outside              Other

Do you have a fenced yard?              Yes              No
 
What type of fence & how high? ______________________________________________________________________________
 
Approx. what is the size of your yard?__________________________________________________________________________

 How many hours per day will the dog be alone?  _________________________________________________________________
 
Do you have a doggie door?__________________________________________________________________________________
 
Where will the dog stay when left alone?
 
      Fenced Yard
      Outside Pen
      Inside in Crate
      Gated Room in House
      Free Range of House
      Garage
      Laundry Room
      Other (specify)
 

Describe the activity level in your home:                                 
              Busy (visits by friends, meetings, children, parties at home)
              Noisy (TV, stereo, machinery, tools, children playing, dogs barking)
              Moderate (Normal comings and goings)
              Quiet (homebodies, few guests)
              Other (specify) 
 
What is your reason for considering this dog and/or breed?
          Family companion
          Exercise partner     
          Playmate for children
          Playmate for current dog(s)
          Protection or guard dog
          Service or therapy dog (Trainer Contact Info required)
          Other
 
 In the absence of the primary caregiver, who will care for the dog?  This may include going on vacations, being in the hospital, etc.
 
 
 Under what circumstances would you return the dog?
        New Job            Divorce            New Baby            Children lost interest             Allergies            Moving                                              
        Pet’s medical issues             Doesn’t get along with other pets                Behavioral Problems                  
        Housebreaking Issues              Too time consuming                Aggressive Behavior 
        Other (specify)

Are you willing to take responsibility if this pet acquires an illness?
               Yes             No

What brand of dog food do you feed or will be feeding?________________________________________________________________

Are you willing to feed a raw home made diet?_______________________________________________________________________


Are you willing to take the time to work with a dog on behavior issues should they arise?    Yes       No 
 
 Would you consider obedience training for your new dog?      Yes       No

 Pet Information:
Have you had pets in the last seven years?
     Yes         No
If yes, complete the following chart. Please list past & current

Name of Pets AND Breed ________________________________________________________________________________________
Age of dog & Years Owned______________________________
Spayed/Neutered______________________________________
Inside/Outside_________________________________________
Approximate % of time inside and outside___________________
Do you still have this pet? If not, why?______________________

Current vet name of clinic: _____________________________________________________________________________________

Address:___________________________________________________________________________________________________

Phone:_____________________________________________________________________________________________________


 
 Have you ever had to surrender or re-homed an animal?       Yes         No            Please explain:
 
 
 
 
 
Personal References:
Name:  __________________________________________________         Name: __________________________________________
Relationship:______________________________________________         Relationship______________________________________
Phone:___________________________________________________        Phone: __________________________________________

 
Name:____________________________________________________
Relationship:_______________________________________________
Phone: ___________________________________________________
 
 
 
 
 
 
 
 
 
 
 
 
 
Do you have any other comments?
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
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