Your Information   * Required Information Name    * Address   City   Prov/State Code   Postal Code/Zip Code   Home Phone Number   Work Phone Number   Fax Number   Email Address   * What is a good time to call if we need to reach you?   Please Choose One 00:00 - 02:00 02:00 - 04:00 04:00 - 06:00 06:00 - 08:00 08:00 - 10:00 10:00 - 12:00 12:00 - 14:00 14:00 - 16:00 16:00 - 18:00 18:00 - 20:00 20:00 - 22:00 22:00 - 24:00 Don't Call Me Please At? Home Work How were you referred to us? Please Choose One Other Breeder (Please list in Other) Web Site (Please list in Other) Web Search By Chance Word Of Mouth Other Other Dog Information You are interested in a   Please Choose One Male Female No Preference Why are you interested in obtaining one of our Dalmatians? (Check all that Apply) Companion Show Breeding Obedience Protection Other   Additional Information What qualities do you like in the Dalmatian? What don't you want to find in a Dalmatian? Is this your first Dalmatian? N/AYesNo Have you ever owned another dog(s)? N/AYesNo If you've owned dogs before what happened to them? How many animals do you presently have at home? Choose One None 1 2 3 4 5 or more Have you ever had to euthanize (put to sleep) a dog? N/AYesNo If so, why? Are you willing to take this pup to handling classes? N/AYesNo How will you transport the dog? If just a pet, are you willing to spay/neuter this dog? N/AYesNo If no, why? If you are considering breeding, do you promise to have this dog checked for Hip Dysplasia, Certified Baer Tested and to consult us prior to Breeding? N/AYesNo How many Litters have you bred in how many years? Litters   N/A 1 2 3 4 5+ Years   N/A 1 2 3 4 5+ What are your reasons for breeding Dalmatians? Personal Information Are you Married Divorced Single What is your age? Please Choose One 18-25 26-30 31-35 36-40 41-45 46-50 51-55 56-60 61-65 66-70 71-75 75+ Do you have any children living at home? N/A Yes No If Yes what ages? (Check all that apply) 0-6mos 6mos-1yr 1yr-2yr 2yr-3yr 4yr-5yr 6yr-8yr 9yr-11yr 11yr-13 13+ What are the occupations of the adults in the household? Are there others who will have contact with the dog?   N/AYesNo Where will the dog stay during the day? How many hours will the dog be left alone during the day? 0 1-3 3-5 5-7 8-10 10+ Where will the dog stay during the night? Please explain your housing situation: Choose One Urban Suburban Rural Choose One Condo House Apartment Farm Do you have a fenced in yard? N/A Yes No Does your particular lifestyle have room for a dog of this size? N/A Yes No Are you committed to caring for this dog it's entire lifetime? N/A Yes No What books have you read on dog care and training? Please add any other information you wish us to consider in placing one of our dalmatians with you. We would appreciate it if you would give us a little insight into the expectations you may have for this new addition to your family. Thank You - Your Interest Is Appreciated. Please read our Privacy Policy. Please note that the information collected through our Customer Contact Form is delivered via email to us.