Full Name:

Email Address:

Contact Number/s:

Physical Address:

Province:

Name of Closest Airport:

Would you prefer a male or female puppy? Would you prefer a male or female puppy? Male Female Either

If other, please specify:

Have you ever owned a dog before? Have you ever owned a dog before? Yes No

Have you owned a rottweiler or a working dog breed before? Have you owned a rottweiler or a working dog breed before? No, none of the above Yes, Rottweiler Yes, Working Breed (German Shepherd, Doberman, Border Collie, etc.)

Are there any dogs currently living on your property? Are there any dogs currently living on your property? Yes No

Please provide their breed, age, gender, and if spayed/neutered:

Are there any children living in your home? Are there any children living in your home? Yes No

Please provide their ages:

Is your property enclosed? Is your property enclosed? Yes No

About how high (in meters) is your fence/wall?

Please provide the name and contact details of your vet (if applicable):

Do you have any questions, inquires, or comments for us?