Elaine Bartlett’s Brittany Purchase Questionnaire P O Box 233868 Anchorage, AK 99523-3868 (907) 561-0405 elainebartlett@yahoo.com Anyone interested in getting a puppy/dog or on the puppy waiting list, must fill out a questionnaire. This questionnaire helps me to make sure my Brittany puppies and you would be a good match. It also helps me to know what questions to ask during our face-to-face or phone interview. This questionnaire is the first step. Some of the questions may seem silly...some may seem intrusive. Please remember that I'm not trying to pry. I'm just trying to make sure the puppies I help to bring into the world go into the best possible homes Your Contact Information: Today's Date: _____________________________________________________ Your name: ______________________________________________________ Your address: _____________________________________________________ ________________________________________________________________ City, State Zip Your phone number: _______________________________________________ Don't forget your area code. Your e-mail address: _______________________________________________ How would you prefer I contact you? Phone OR Email If by phone...what time would you prefer I call? ___________________________ What time zone are you in? Eastern, Central, Mountain, Pacific, OR Other If OTHER, what time zone? __________________________________________ Your Puppy/Dog Preferences: Are you interested in a particular puppy/dog on my site? Yes OR No Name of puppy/dog. ________________________________________________ What sex puppy/dog are you looking for? Male OR Female OR Either If your chosen sex is NOT available, are you interested in getting a puppy/dog of the other sex? Yes OR No OR Not Sure What color puppy/dog are you looking for? You MAY choose more than one. Number them if you have an order of preference. Orange and White Liver and White Orange Roan Liver Roan Tri Color Understand that a Tri Colored Brittany is NOT a preferred color per the AKC Breed Standard and all Tri Color puppies will be sold with a spay/neuter contract and with LIMITED AKC Registration. Tri Colors are NOT breeding/show prospects. What age puppy/dog are you looking for? Not Sure Under 3 Months old Under 6 Months old Under 1 year old 1-3 years old Over 3 years old Is this puppy/dog for yourself or another member of your household? Yes OR No If NO, who is the puppy/dog for? ______________________________________ Is this puppy/dog for a surprise gift? Yes OR No What are your plans for this puppy/dog? Check ALL that apply. Pet/Companion Breeding Prospect Confirmation Show Prospect Hunting Prospect Agility Prospect Obedience Prospect Other If OTHER, please describe. Your Dog History: Have you ever owned a dog before? Yes OR No How long ago? I've never owned a dog. I own dog(s) now. When I was a child. Less than a year ago. More than a year ago, but less than 5 years ago. Over 5 years ago. If YES to above question...have you ever owned a Brittany before? Yes OR No How long ago? I've never owned a Brittany. I own a Brittany(s) now. When I was a child. Less than a year ago. More than a year ago, but less than 5 years ago. Over 5 years ago. In the area below, please, tell me about any pets you CURRENTLY have including type (dog, cat, gold fish...etc.) / breed / sex / age, or anything else you think would be helpful. Please tell me about any pets you've had in the past 5 years, but no longer own. What happened to them? Have you (in the past 5 years) given a dog away, returned a dog to the breeder, or turned a dog over to a shelter or rescue group? Yes OR No If YES, when and why? Why are you interested in getting a Brittany at this time? Your Home Environment: In the area below, please, tell me about the members of your household. Please list all adults, and the sex and ages of all children. Are you planning to add other members or pets to your household (someone moving in, birth of a child, getting a cat) in the near future? Yes OR No If YES, please describe. What type of home do you live in? House Apartment Trailer/Mobile Home Other If OTHER, please describe? How long have you been in this home? _____________ months OR years Do you… own OR rent If you RENT, do you have your landlord's permission to keep this type of dog? Yes OR No If NO, what are your plans to resolve this? May I speak with your landlord? Yes OR No Landlord's name: __________________________________________________ Landlord's phone: _________________________________________________ Do you have a fenced yard? Yes OR No If YES, yes please describe the type (chain link, wooden) and the height. Do you have a separate kennel run for the dog? Yes OR No If YES, yes please describe the type, height, and flooring. If you do not have a fenced yard or kennel, how will you handle the dog's exercise and toilet duties? How the puppy/dog will spend an average day: How many hours (in the average day) will the puppy/dog spend alone? ________ Where will the puppy/dog spend most of the day? loose indoors confined to part of the house loose in fenced yard kennel run garage basement loose outdoors (no fence) tied in yard crate If OTHER, please describe? How will the puppy/dog spend the night? loose indoors confined to part of the house loose in fenced yard kennel run garage basement loose outdoors (no fence) tied in yard crate If OTHER, please describe? Last Little Bit: Would you be willing to let me visit your home by appointment? Yes OR No Are you over 18 years old? Yes OR No If NO, do you have your parent's permission and support in getting this dog? Yes OR No Parent’s name: ____________________________________________________ Parent's phone: ___________________________________________________ Please list at least one personal reference. Include a name and phone number for each. Thank you so much for filling out this questionnaire. I know it's a little lengthy, but it really helps me in placing puppies into compatible homes. Please add any comments you have below: