1.   

Employer (Primary): 

 2.   

Occupation: 

3.   

Average hours worked weekly: 

4.   

Number of adults living in household: 

5.   

Hours adults are home daily (including yourself): 

6.   

Number of children living in your household:    Ages: 

7.   

What type of area do you live in?  City   Suburban   Country

 8.   

What type of housing:  Apt.   Condo   Duplex   House   Other
(please explain, how long you have lived here, etc.) 

9.   

If you rent or lease, do you have permission from your landlord to own a Rottweiler?
Yes     No

(Name and Phone number of your landlord) 

If less than two years, please list your previous address:

10.   

What breed of dogs have you previously owned and what happened to them?

Were they spayed/neutered?  Yes   No  (both as appropriate)

11.   

Is everyone in your household in agreement on purchasing a Rottweiler?  Yes  No

12.   

Other pets in the household -- breed, age, spayed/neutered, up to date in vaccinations:

13.   

What do you know about the Rottweiler as a breed?

14.   

Why do you want a Rottweiler, please be specific, this will determine which puppy you get?

15.   

How did you hear about us, and/or  who referred you to us?

16.   

What other individuals have you applied with?

17.   

Do you have a preference as to what sex the Rottweiler is?  Yes   No
If "yes," why?

18.   

Do you have a fenced yard?  Yes   No
Specifically, what kind of fence and how tall:

If Not fenced, where will this Rottweiler  be exercised and allowed to eliminate?

19.   

What member of the family will be taking the MAJOR responsibility for raising and taking care of this Rottweiler?

20.   

What are your plans for this Rottweiler, please be specific?

21.   

Will you take your Rottweiler to an obedience class?  Yes    No

(If you are not willing to take the Rottweiler to obedience class please explain
why)

22.   

Do you have a homeowners or renters insurance policy? If so, does it allowed you to own a Rottweiler?    Yes    No

Name of Homeowners or Renters Insurance Policy Carrier

23.   

Do you have a city or county ordinance that limits the number of dogs you are allowed to have in your home?    Yes    No If yes how many?

24.   

Will the Rottweiler live inside the home?    Yes    No

 If no, where?

25.   

Where EXACTLY will the Rottweiler sleep at night and where will he/she be kept when there is no one at home?

26.   

Have you ever used a crate before?    Yes    No
Do you have an objection to using a crate?  Yes    No   If yes, why?

27.   

What are the major sports, activities, hobbies, or exercises you and your family participate in most?

28.   

Please list your veterinarian's name/address/phone number. 
Call your vet and advise them that I may be checking on the health care of your previous/current pets.

29.   

What is your estimate of cost for a dog during a year?  (ex., vet expense,  food, toys, training, etc.) 

30.   

Please list names, addresses and phone numbers of three personal references that have known you for at least two years:
   

31.   

Are you currently or previously involved with any dog clubs, Humane Societies, etc.?  Yes     No
If "yes," what club?

32.   

How long do you plan to keep this Rottweiler?

 33.  

What kind of food ( Brand Name) do you feed or plan to feed? Would you have a problem with feeding what we recommend?Yes  No

34. 

Who have you purchased/adopted a Rottweiler in the past?  List all:

35.

Do you realize that purchasing a Rottweiler requires ongoing training and socialization and will require a lot of time to train and socialize this puppy?  Yes    No
 

36.   

Are you willing to work with us in helping you pick the perfect puppy for you? Yes    No

37.

You as the Buyer also understand that there is an contract and have read the contract and understand it fully?Yes    No

38. 

Any additional comments you may have:

39. 

I certify that the information provided on this form is true & correct. I am also financially and physically able to care for this animal. I understand that proper food and veterinarian care can be costly and I am able to meet these requirements.

Electronic E-Signature