Date

  Name(s)

   Address

            City      State      Zip

Telephone      Work Phone

       E-mail

  Web Site

________________________________________________________________________________

Members of Household with Children's Ages
and Adult's Occupation (optional)

Family's Favorite Form of Recreation

Is someone home during the day?  yes      no

Do you live in a house?      condominium?      apartment?      own?      rent?

How will the puppy spend the day?

How will the puppy spend the day when he becomes an adult?

Where will the dog sleep?

Will  someone able to spend more time with the puppy with he first goes home? yes      no

Do you own a dog or any other pets presently?  List their breed, sex and age.

Have you owned dogs in the past?  Please explain.

Do you have strong feelings about owning a male or female dog, and why?

Are you looking for a puppy?   Are you looking for an older dog?   Either?

Do you want a Smooth for a companion/pet?      show prospect?      obedience prospect

     protection      breeding prospect      (companions are not sold for breeding)

Do you have any experience in showing, obedience training or breeding?

Have you ever attended a dog show or obedience trial? yes      no

Please give us an estimate or time-frame as to when you are looking for a dog:

Immediately    3-6 months    Within a year    Longer

Veterinarian References

What attracts you to Smooth Fox Terriers?

How were you referred to Bluestone Kennels?