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Your Information

Name:

Email:

Phone:

Street:

City:

State:

Zip Code:

Age:

Occupation:

Co-Applicant (if applicable)

Co-Applicant Name:

Co-Applicant Occupation:

Co-Applicant Age:

Co-Applicant Phone:

Type of Residence:

OwnRent

How long you’ve lived at this address:

Landlord Name (if applicable):

Landlord Phone (if applicable):

Size of Living Area:

Size of Yard:

Fenced in yard:

YesNo

Height of Fence (if applicable):

If the yard is not fenced, how will you exercise/potty the dog?

Dog size or weight restrictions in the residence?

Do you plan to move in the near year?

YesNo

Do you have any children that live in your home?

YesNo

If you have children, what are the genders and ages of each?

Other residents besides spouse and children:

Number and ages of other adults in household:

Are all members of the house aware of the new dog?

YesNo

Do all household members approve of the new dog?

YesNo

Dog Information

Who will be the primary caretaker:

What is your level of activity?

HighMediumLow

How many dogs do you currently own?

0123+

If you have other dogs, what is the breed, age, and gender of each?

Do you own other pets besides dogs? If so, what are they?

Have you owned dogs in the past?

YesNo

If yes, what breeds were they?

What happened to the other dogs?