PROSPECTIVE PUPPY PURCHASER APPLICATION
* = Required fields! PLEASE NOTE: If I don't have a contact address or phone number I cannot reply to your submission!
Your Name(s):
Address: *
City: *
State: *
Zip Code:
Home Phone (*with area code):
Work Phone (*with area code) :
Cell Phone (*with area code):
Email *(e.g. -johndoe@aol.com)::
Additional Email: *(e.g. -johndoe@aol.com):
Do you live in a: House Apartment Other
If you rent, do you have your landlord's approval to own this dog? Yes No
Do you have a 6 foot fenced yard? Yes No
Type Of Fence: Chain Link Wood Underground Electric Other (The more flexible you are the greater the chance of a perfect match.)
How old are you?
Do you have any children? No Children Infants Over 6 Years Teenagers Grown Family
Are you? Married Single Engaged
Do you have roommates? Yes No
Do you have other dogs/pets of any kind living with you? Yes No
If so, what kind? Dogs Cats Ferrets Rabbits Hamsters Mice Birds Lizards Reptiles Other
Have you ever been owned by a Basenji before? Yes No
What traits are you looking for in a dog?
Why have you decided you would like a Basenji versus another breed?
Have you ever met a Basenji? Yes No
Do you work and if so, choose type of work? Work Full Time Work Part Time Retired Other
Are you interested in a male or female Basenji? Male Female
Do you have a colour preference? Red N White Black N White TriColor Brindle N White
Can you also give me a second/ third colour preference? Red N White Black N White TriColor Brindle N White
Do you have suggestions/ comments/ feedback, that may improve my website for other potential owners?
If so, please submit your comments/suggestions below:
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