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Please tell us a little about yourself.
Name 
Address 
City State Zip
Home phone Work phone
Email address
Do you  Own or   Rent?
Type of Dwelling     House      Condo      Apartment      Mobile home
Do you have a fenced in area for the dog?   Yes     No  If Yes, type of fence:
Dimensions:
If No:
What arrangements will be made to exercise the dog?
Have you ever owned a dog before?    Yes     No  
What breeds?
Do you currently have any other dogs or animals? Please list.
Would you like a  Male  or Female  puppy?

Ages of children (if any)
Is anyone home during the day?    Yes     No             At night?    Yes     No
Is anyone in the home allergic to dogs?    Yes     No
Where will the dog be kept when no one is home?
Where will the dog be kept at night?
Are you willing to have a home visit prior to 
purchasing your puppy?     Yes, please.     No thank you.

It is our practice to sell all puppies with a legally binding purchase agreement which will provide you as the buyer with certain rights and health guarantees and provides us as the breeder with certain assurances that the dog will be adequately cared for.

Do you have any objections to signing such an agreement?  No    Yes

All of the information I have provided on this questionnaire is, to the best of my knowledge, true and complete. I agree that completion and submittal of this questionnaire does not in any way obligate Bluebelle Bassets to provide a dog for purchase.

Please copy/paste the completed questionnaire in an email and email to us.

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