Name:

Address:

City/State/Zip:

Home Phone:              E-Mail address:

Place of Employment:

Spouse's Employment:

Work Phone: :    Spouse Work Phone:

Are you looking for a puppy or an older dog:

Any sex or color preferences:

Number of children and their ages: 

Other Pets:

Who in the household wants the dog? 

Have you owned Bouviers before? 

If so, what is your most and least favorite things about the breed, and if not why do you want a Bouvier?

Who will be the primary caretaker of the dog, or how do you expect the duties (training, grooming, etc.) to be divided?

Veterinarian name, address and phone number:

Tell me a little about your previous dogs, where you got them and what happened to them:

Any activities you plan on doing with the dog(s)?

Please complete the following statement by choosing all that apply:
I am interested in getting a Bouvier for a or to be involved in:

Conformation              Breeding            Companion            Family Member          Herding

Agility        Obedience           Tracking         Schutzhund          Ring Sport      Police Work

Personal Protection       Carting       Search and Rescue        Therapy Work           

Personal assist dog        Hiking/Backpacking Companion        Couch & Bed Warmer   

Other plans or desires for your dog: 

Have you recently been involved in any training or activities with your dogs, and if so can you please give me the name & contact information for the trainer or group?

Where will the dog spend it's days?
Nights?

Any other information you can provide that will give me a complete picture of how my dog will live and what you are looking for in the perfect Bouvier: