Your Name:

Address:

Address 2:

City, State, Zip:

Country

Phone (day):  

Phone (fax):  

Phone (eve) : 

Phone (work): 

Phone (cell):  

Phone (other):

How would you like to be contacted?     Home Email Work Fax Email/Home Cell Other

E-Mail:

What sex are you looking for?     Male Female Either

What age are you looking for?     Puppy Adult Rescue Any

Color Preference?     Black White/Black Black/White Brindle Brindle/white Tri -Blk/Wht/Gold Gold/White No Color Preference

How soon are you looking to get a Tibetan?     Within 3 months Within 6 months Within 12 months Undecided Now

Describe yourself / family / children / other pets

Have you ever owned a dog before?

      Yes

No

Do you have a vetrinarian?

      Yes

No

If so, please provide veterinarian's name and contact info?

How long have you used this veterinarian?     Over 5 years 1-5 years Less than 1 year

How are you going to train your Tibetan Terrier?

Is someone home during the day?        Yes No Part of the time Most of the time

If not, what arrangements can be made to assure the comfort and care of your puppy?

How did you hear about Dioghe’s web site?

Do you have a fenced yard?

      Yes

No

What is the approximate size of your yard?

Do you have an Electric Fence?

      Yes

No

Will you leash walk the dog?

      Yes

No

Will you let dog out in yard?

      Yes

No