Puppy Application

We appreciate your taking the time to complete and return the following form. Detailed information regarding your lifestyle and experience with dogs helps us in selecting the right puppy for you and your family. Please fill in the form below.

Contact Information
* First Name:	* Last Name:	2nd Contact Person:
* Street Address:	* City:	* State: Select a State Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Dist. of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming	* Zip Code:
* Home Phone:	* Work or Cell Phone:	* Email Address:

Interview
* Have you ever owned a dog before? Yes No	* If yes, what breed?
* What other animals live in your house?
What is the most important reason(s) for purchasing a Samoyed? (check all that apply): Family Companion Show Dog Obedience Companion Breeding A Dog for the Kids Pet Therapy Agility / Fly Ball Competition Other
If other, please specify.
* Do you prefer a male or female puppy/dog? Male Female

Family Profile

What is your marital status / living arrangement? (choose best fit): Married Single Separated Widowed Live with Parent/Relative Live with Other

* Number of children in household and/or who visit on a regular basis (include their ages):

* If you don't currently have children, are you planning to start a family in the future? Yes No

Property Profile
* What type of area do you live in? City Suburb Subdivision Country
* Is your yard fenced? Yes No	* Fence type?	* Fence height?
If you do not have a fenced yard, where & how will the dog be exercised & be allowed to eliminate?
* Do you have a deck? Yes No	* Is there a railing? Yes No

Arrangements

* Will the puppy/dog be kept: Inside Outside In Yard Loose Kennel Run Garage Basement Other

If other, explain.

Where will the puppy/dog sleep at night?

Where will the puppy/dog be kept when there is no one at home?

Additional Information

Please add other information that would be helpful in placing a puppy with you:

Thank you for your interest in White Magic Samoyeds.