|
|
|
|
|
|
Pet
Pre-Sale Questionnaire
Name_________________________________________________ Address,______________________________________________ City_________________________
State,________ Zip.________ Day Phone# ( )___________ Night
Phone# (
) ______________ Email
Address:__________________________________________ Occupation:
_____________________________Phone # ( )
_____________ Personal
references: (Please give at least three) a.
Name,_____________________ Phone#________
Relationship________ b. Name,
_____________________ Phone#________ Relationship_______ c. Name,
_____________________ Phone#, ________ Relationship_______ d. Name
_____________________Phone#__________Relationship_______ e. Name,
_____________________ Phone#_________ Relationship______
1. WHY DO YOU
WANT TO BUY A MALTESE (Choose only one) a. Companion for
another pet: ______b, Companion for Self____________ b.
Protection________d, Gift____ e, Surprise Gift___ f,
watchdog ____ g. Replacement
Pet: ____ h, To Breed: ____ 1, To Sell: _____
2. THE NUMBER OF
PEOPLE BY CATEGORY THAT LIVE IN THE HOUSEHOLD? a. Adults (19 to
65)______ b, Seniors (over 65)_______ b. Adolescents
(12 to 18) _____ d, Children (3 to 12)_______ e. Infants
(under 3) _______
3. HOW MANY
PEOPLE LIVE IN THE HOUSEHOLD? ______________
4. ARE THERE
REGULAR VISTORS TO YOUR HOME (Human & Animal) WITH WHOM
YOUR NEW DOG MUST GET ALONG WITH? __________________
5. DO CHILDREN
VISIT YOUR HOME? a. Yes____ b. No, _____ IF YES, AGES
& HOW FREQUENTLY ________________________________
6. HOW WOULD YOU
RATE YOUR GENERAL KNOWLWDGE OFTHE MALTESE YOU'RE INTERESTED
IN BUYING? a. Very
Knowledgeable _______b, Somewhat Knowledgeable _______ c. Little or No
Knowledge__________
7. HOW LONG HAVE
YOU BEEN ACTIVELY LOOKING FOR A MALTESE? (Choose only one)
a, No. Days_____ b, No. Weeks_____ c, No.Months ______
8. HAVE YOU
OWNED A MALTESE BEFORE?____ IF NO, HOW DID YOU LEARN ABOUT
THIS BREED? (Books, friends,
TV, Internet, etc. _____________________________________________________________
9. DO YOU
UNDERSTAND THE GROOMING NEEDS OF A MALTESE: brushing,
combing, trimming of nails and feet, frequent bathing, ears,
and teeth?______
10. WHAT HAVE
YOU DONETO PREPARE FOR ONE? _____________________________________________________________
11. ANY OTHER
PETS IN THE HOUSEHOLD NOW? A, Yes_____- b, No _______
12. IF 11 YES IS
CHECKED, PLEASE PROVIDE THE FOLLOWING INFORMATION? TYPE OF PET
SEX Spayed
WHERE PET STAY
Neutered Cat
Dog
Others
M F
Age Yes
No
Inside Outside
13. IF THERE IS
NO PETS IN HOUSEHOLD NOW, HAVE YOU OWNED ANY PETS BEFORE? a,
Yes _____b,No______
14. IF YOU OWNED
PETS BEFORE, WHERE IS HE/SHE/THEY NOW? a, Don' t Know
_________ b, Gave A way ____, c, Lost, Never Found,____ d, Died____ e,
Sold ____f, Never Owned.____
15.HAVE YOU EVER
RETURNED A PET TO THE BREEDER?_______IF SO, WHAT WERE THE
CIRCUMSTANCES?__________________________________________________
16. HAVE YOU
EVER GIVEN A PET AWAY?_______ IF SO, WHAT WERE THE
CIRCUMSTANCES?_______
17. HAVE YOU
EVER TAKEN A PET TO A POUND OR
SHELTER?_______________________________
18 IF ANY PETS
DIED IN THE LAST 12 MONTHS, WHAT WERE THE CIRCUMSTANCES? ________________________________________________
19. NAME/
ADDRESS/PHONE # OF VETERINARIAN OR CLINIC USED BEFORE: ____________________________________________________________
20.NAME/ADDRESS/PHONE
# OF VET OR CLINIC TO BE USED FOR THE NEW PET? ____________________________________________________________
21. WHERE WILL
THE NEW PET SPEND MOST OF HIS/HER TIME? a. Inside_____
b, Outside_____ c, Inside & Outside _______
22. WHERE WILL
NEW PET STA y WHEN NO ONE IS HOME? a. Inside
_____.b, Outside _____c, Inside & Outside,_____
23. WHERE WILL
DOG SPEND THE NIGHT? (Circle what applies): Indoors, Loose,
Bedroom, Crate, Basement, Garage, Other
(describe):______________
24. DESCRIBE THE
PET' S OUTSIDE ENVIRONMENT (fype Shelter, Fenced yard,Etc.) _____________________________________________________________
25. DO YOU HA VE
A FENCED YARD?____ DOES FENCING COMPLETELY ENCLOSE A YARD
FOR DOG?_______ LIST
HEIGHT AND TYPE ________________________
26. ON AVERAGE,
HOW MANY DAYS A WEEK WILL PET BE LEFT ALONE? O___ 1___ 2
___3____4___ .5___ 6___7___
27.0N AVERAGE,
HOW MANY HOURS A DAY WILL PET BE LEFT ALONE? a. O to 3____ b,
4 to 6____ c, 7 10 8____ d, Over 8 hours,_____
28. HOW LONG DO
YOU INTEND TO KEEP PET? _____________________________________________________________
29. HAVE YOU
EVER HOUSE TRAINED A DOG BEFORE? A. Yes______ b. No_______
30. WHAT KIND OF
FLOOR SURFACES WILL THE DOG BE ON IN THE HOUSE? ______________________________________________________________
31. DO YOU PLAN
TO ATTEND ANY TYPE OF TRAINING CLASSES? IF YES, WHAT AGE
WILL THE PUPPY BE WHEN YOU START?
___________________________________________________________
32. HOW AND
WHERE WILL PET BE EXPECTED TO RELIEVE HIM/HERSELF? a. Inside, on
own____ b, Outside, on leash____ c, Outside, Fenced-in
area__ d. Outside, Tied/Chained ____e, Outside, Other____ f,
Don't know ____
33. IF A TOILET
SCHEDULE IS NECESSARY, WHEN WILL PET BE ALLOWED TO RELIEVE
HIM/HERSELF? a. Whenever Pet
signals to owner___ b, every few hours,_______ c, at certain
times a day _______d, don' t know._______
34.IF NO FENCE
OR ON RAINY DAYS, HOW WILL YOU HANDLE DOG' S EXERCISE AND
TOILET DUTIES _________________________________________________
35. WHAT AGE
GROUP WILL HAVE PRIMARY RESPONSIBILITY FOR HOUSEBREAKING
PET? a. Adult (19and
over)______ b, Adolescent (12 to 18)______ c, Child (under
age 12) ______d, Not applicable______
36. HOW MANY
PERSONS WILL BE RESPONSIBLE FOR HOUSEBREAKING OR TRAINING
THE PET? a. 1-person___ b,
2-persons___ e, 3-persons___d, 4 or more___ 37. WHA T WILL
YOU DO IF YOUR DOG IS DESTRUCTIVE TO FURNlTURE? ____________________________________________________________
38. WHAT IFTHE
DOG BARKS EXCESSIVELY? ____________________________________________________________
39. WHA T IF THE
DOG IS NOT HOUSEBROKEN? ____________________________________________________________
40. WHO WILL BE
FINANCIALLY RESPONSIBLE FOR PET? a. Selfl
Adult____ b, Minor____c, Spouse_____ d,
ParentlGuardian______
41. HOW MUCH
MONEY WILL YOU BUDGET FOR HIS/HER CARE EACH MONTH? Consider
Food, MedicalTreatment, Boarding, Flea/Tick Control, Annual
Rabies Shots, Vaccinations, Grooming expenses, etc. a.$5 to $10___b,
$11 to $20___c, $21 to $30___ d, $31 to $4O____ e, Over $41_____
42. IS YOUR
RESIDENCE IN THE... a. City___ b, Town___ c, County___
43. RESIDENTIAL
AREA IS DESCRIBED AS: a. Urban___ b, Suburban___ c, Rural__
44. TYPE
RESIDENCE: a. Single
Family____b, Duplex____ c, Apartment___ d, Condominium.
Townhouse-___ f, Mobile Home___ g, Rooming House ___ h,
Dormitory____
45. LENGTH OF
TIME LIVING AT THIS ADDRESS: a. Less than 1
year___ b, 1 to 3 years___ c, Over 3 years___
46. OWN OR RENT
RESIDENCE? a. Own____ b,
Rent,____
47. IF RENTING,
WHAT ARE THE PET REGULATIONS? (Deposits, Number& Size
Limits) _______________________________________________________________
48. DO YOU HAVE
LANDLORD'S PERMISSION TO KEEP A DOG? a. Yes___b.No_____
49.LANDLORD'S
NAME AND PHONE NUMBER _______________________________
50. ARE YOU
FAMILIAR WITH CRA TING DOGS? a. Yes ____b,No,____
51. WHA T ARE
YOUR FEELINGS ABOUT CRATING YOUR DOG? ______________________________________________________________
52. WHAT
TRAINING (if any) D0 YOU PLAN TO GIVE TRIS DOG? _______________________________________________________________
53. HOW MUCH
TIME WOULD YOU CONSIDER REASONABLE FOR YOUR DOG TO BECOME
ACCUSTOMED TO HIS/HER NEW HOME? _______________________________________________________________
54. ARE YOU
WILLING TO CARE FOR THIS DOG FOR THE REST OF HIS/HER LIFE: a. Yes______ b,
No______,
55. WILL YOU
ALLOW THE BREEDER TO CONDUCT PRE-AND/OR POST HOME INSPECTION
VISITS? a.Yes________ b,
No, _________
Agreement 1. WILL YOU
AGREE TO ABIDE BY ALL ANIMAL CONTROL LAWS IN YOUR AREA,
INCLUDING LICENSING? a.Yes____ b, No ____
2. DO YOU
UNDERSTAND THAT IF ANY TIME YOU CANNOT OR DO NOT WISH TO
KEEP THE DOG, THAT YOU MUST CONTACT THE BREEDER? a. Yes____
b, No____
3. DO YOU
UNDERST A T AND THAT IF THE TERMS OF THE PURCHASING CONTRACT
YOU SIGN UPON PURCHASING A DOG FROM THE BREEDER ARE NOT
FOLLOWED, THE BREEDER MAY RECLAIM THE DOG AND SEEK
RESTITUTION FOR ALL EXPENSES INCURRED? a. Yes____ b, No____
4. DO YOU
REALIZE THAT THIS DOG WILL BE STRESSED UNTIL IT CAN ADJUST
TO HIS/HER NEW HOME AND THAT THE DOG SHOULD BE KEPT IN A
QUIET AND SECURE ENVIRONMENT DURING THE ADJUSTMENT PERIOD?
a, Yes____ b, No, ____
5. DO YOU
REALIZE THAT DOGS SHOULD NEVER BE LEFT ALONE WITH CHILDREN
WHO ARE UNSUPERVISED FOR THE SAFETY OF BOTH? a. Yes___ b, No
____
6. DO YOU
REALIZE THAT CHILDREN AND DOGS NEED TO BE TAUGHT PROPER
BEHAVIOR TOWARD EACH OTHER? a, Yes____ b, No____
7. DO YOU
UNDERSTAND THAT THE MALTESE IS A FRAGILE LITTLE DOG AND
COULD EASILY BE INJURED? a, Yes____ b. No ____
8. DO YOU
UNDERSTAND THAT A MALTESE SOLD AS A PET MUST BE
SPAYED/NEUTERED? A.Yes_______ b,
No_________
I certify that
the above information is accurate and complete. I authorize
the release of veterinary
information related to my current and past pets. I authorize
my landlord to verify my
ability to house a pet on his property. I realize that the
breeder reserves the right to
deny any application. a. Yes ______b.
No. ______
SIGNED: ______________________________________________________
|