NAME:
ADDRESS:
CITY, STATE ZIP:
PHONE NUMBER:
EMAIL:
1) How did you find us?

2) What made you decide on an Australian Shepherd to own?

3) Have you done much research into this breed and if so, by what resources?

4) Are you aware of the energy level and intelligence of an Australian Shepherd? Are you fully prepared to handle and channel that energy by adding this new member to your family for the next 15 or more years?

5) Have you ever owned a dog before? Is yes, specify breed and number of dogs you have owned as well as details regarding if/why you no longer have them.

6) Are you looking for a puppy or an adult?
puppy adult doesn't matter

7) Male, Female, or Doesn't matter?
Male Female Doesn't matter

8) Color preference?
Red Red Merle Black Blue Merle Doesn't matter

9) Are you interested in obtaining a show, pet/companion or performance quality puppy/dog?
show companion/pet performace

10) Do you have intentions upon breeding anytime in the future? Have you ever bred any dogs/animals before? If yes, give details:

11) Have you ever shown and/or titled dogs in any venue? (ie:Conformation, Obedience, etc.) If yes, give details:

12) How long have you been at your present address?

13) Do you rent or own your place of residence?
rent own

14) How often have you moved in the last 10 years?

15) Do you have a fenced in yard or property? If not, how do you propose to handle bathroom duties as well as required exercise for this puppy/dog?

16) Where is the primary place this puppy/dog will reside?

17) If your puppy/dog swallowed a sock, and the vet told you it would cost $1500 to do
surgery, what would you do?

18) Give some brief details of your family situation. (ie: Number of immediate members, ages, lifestyle).

19) Would you be willing to have a representative from Image Aussies visit you for a home check prior to placing the puppy with you?
yes no

20) How long will this puppy be left alone during the day?

These questions are asked for information that will be used to determine what puppy/dog would best suit your needs as well as for the well being of our babies. There is no intent of prying or insult, merely fact gathering. Thank you for your assistance and for choosing Image Aussies to provide you with your next family member.

REFERENCES

VETERINARIAN: *note: Please list all if multiple vets have been used.

Name:
Address:
Phone #:

Name:
Address
: Phone #:
FRIEND/FAMILY:

Name:
Address:
Phone #:

ANIMAL OWNER: Ie: Breeder, Handler,Trainer, Boarder

Name:
Address:
Phone #:

PLEASE NOTE: IF REFERENCES ARE NOT ACCEPTED BY SELLER, BUYER WILL BE NOTIFED IN A TIMELY MANNER.