First name		Simon
Last name		Verge
Title		Dr
Address		PO Box 3131
Address (suite)
City		Richmond
State/Province	AB BC MB NB NL NS NT NU ON PE QC SK YT AK AL AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY	QC
Country		Canada
Postal code / Zip code		J0B 2H0
Business phone
Home phone		819-823-5037
Fax number
E-mail		hautboisbmd@gmail.com
URL		www.hautbois.ca

Do you have any other animals at home now ? Yes No Please provide with details ? Dog(s) Cat(s) Horse(s) Other(s)

Do you have any children at home ? Yes No     If yes, what are their ages ?

Does anyone in your household have allergies to animals ?  Yes No   

        If yes, to what and how severe ? 

What is your main occupation ? 

Are you working at home ? Yes No

Have you ever owned a dog before ? Yes No   If yes, which breed(s) ?

Where did you buy your last dog(s) ? Pet shop Puppy mill Specialized breeder (one breed) Animal refuge Other kind of adoption

Have you ever returned a pet to a breeder or given a pet away  ? Yes No

        If so, what were the circumstances ? We were moving We were too busy Behavioral problem with this pet Sick animal Allergies Other reason(s)

Have you ever house trained a dog before ? Yes No

How did you hear about our kennel ? By one of your other puppy buyers Dogs in Canada advertisement Internet research My veterinarian gave me your name

Can you tell us who referred you to us ?

Do you know other people who bought a puppy from us ? Yes No   Who are they ?

Would you like to come and visit us before doing a reservation ?  We already went by your place ! Sorry, we live too far ! This is not necessary We would appreciate !

Would you plan to come by our place and pick your puppy ?       

                         Yes, for sure ! We do not know for now. We would need that you ship the puppy by plane at our expenses.

Type of dwelling ? House Condo Apartment Mobile home

How many hours per day would the puppy be kept outside ? hours

Where would the puppy be kept during the day  ?

Where would the puppy be kept during the night ?

Is anyone home during the day ? Always At lunch only Occasionally Almost never

What kind of floor surfaces will the puppy be on during daytime ? Wood Carpet Ceramics Concrete Ground

What kind of outdoor premises do you have for the puppy ? Fenced yard Suitable pen Unfenced yard

Do you have  any preference in terms of sex ? Male Female Does not matter We do not know yet

Do you have a preference in terms of getting an adult dog -vs- a puppy ? Puppy only Puppy ideally Does not matter Preference for an adult Adult dog only

Do you intend to breed the dog ? Absolutely not ! If it is possible Maybe

Do you understand the difference between a show/breeding quality puppy and a pet quality puppy (sold under a non-breeding agreement) ? Yes We would need more explanations Not at all

What are you looking for in terms of dog and contract (options are presented in a decreasing order of costs and multiple selection is accepted) ?

  Coownership - Show/breeding quality puppy Ownership - Pet quality puppy Ownership - Pet quality young adult Home for a show/breeding quality puppy, still owned by the breeder Home for a retired show/breeding quality adult

Would you have an interest in offering a permanent home for a breeding/showing quality puppy that your breeder may intend to show or breed ?  Yes, for sure ! Maybe Not at all

Which implication would be suitable for you in terms of breeding or showing ? We want to be involved in everything We would let everything go as you want

Would you like your dog doing a show carreer  ? Yes, for sure Maybe No interest at all

Would you agree having your breeder doing reproduction with your dog or bitch ? Yes, for sure ! Maybe Not at all !