Hollie Eller
Po Box 1519
Orofino,ID 83544
(208)476‑0221
POTENTIAL PUPPY/DOG CLIENT INFORMATION
Thank you for your interest in our dogs. We would appreciate your answering the following questions so that we can more easily test and select the right puppy/dog for you. All information is confidential. Thank you for your cooperation and help in answering our questions. (If no phone number is given this application shall be ignored).
Name: _________________________________________________________________
Address: __________________________ City: ______________________________
State: _____ Zip: ________ Phone: ______________ Work: _________________
Kennel Name: _______________________________________
E‑mail Address: ______________________________________
Website Address: ____________________________________
Do you own any other samoyed Male / Female? _____________________________
If yes, how many? _______ Are they altered or intact? ______________________
Where did you acquire it (them)? _________________________________________
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If you have never owned an Samoyed, why do you want one now? _______________
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What types of research have you done on the Samoyed? ________________________
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What are you looking for in an Samoyed? Show Quality or Companionship? ___________________________________________________________________
Do you prefer a male or female? __________________________________________
Please specify above: Male ‑ Female or No Preference
What specific traits do you want in an Samoyed? ___________________________________________________________________
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Do you intend to breed this Samoyed? ______________________________________
What type of dwelling do you live in? _______________________________________
Please specify‑ House, Condo, Apartment, or Mobile Home or other.
Do you own or rent your residence? ________________________________________
If you rent, does your landlord approve of a Samoyed? Or if you own do you have an association in your neighborhood and do they have any issues with Samoyeds? ____________________________________________________________________
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7. Do you have children? If yes, how many and their ages? _______________________
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8. Do you have any other pets? If yes, what types/breeds? _______________________
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9. Have you ever returned an animal from where you purchased or acquired it? What was the reason, if yes? _______________________________________________________________________
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Do you have a fenced dog run or yard? How tall is the fence? What are the dimensions of the run? ___________________________________________________________________________________
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Please provide photos of your house, (with address clearly visible on the front of house) yard, fence and dog area.
Where will your Samoyed spend its time? Outside, inside the home, a run, or crate, etc.? ___________________________________________________________________________________
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If you live in a state that experiences extreme summer or winter weather conditions, what type of means do you have to care for your Samoyeds in these conditions? ________________________________________________________________________
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How many hours on the average will the puppy be left alone? _________________________
Will you allow an in home visit by Northfork Samoyeds or by a representative for Northfork Samoyeds, before placement of a puppy? ______________________________________________________
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Are you interested in competing in performance events such as obedience, agility, tracking, hunting and herding, etc.? ___________________________________________________________________
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Are you willing and able to attend any training classes with your Samoyed? If yes, at what age will you start? ________________________________________________________________________
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Have you ever bred a litter of dogs? If yes, what kind and how many? ________________________________________________________________________
Mail back this signed application to Northfork Samoyeds
also be sure to provide us with pictures of your yard, home and fencing.
Signature: _______________________________________ Date: ____________
Signature: _______________________________________ Date: ____________
Please use the back to add any other information you wish us to consider in placing one of our Samoyeds 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 again your interest, it is deeply appreciated.
Hollie Eller