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?
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?
