IMAGE AUSSIES
Date
Name
Address
City, State,
and zip
Email:
Phone:
How did you find us?
Have you ever owned an Australian Shepherd
before?  Any other breed of dog?
 No
Yes
If you answered 'yes' to the above question, please
provide details of dogs you have owned as well as
if/why you no longer have them.
What are you hoping to obtain?
Color:
Do you have any intentions upon
breeding in the future?  Have you
ever bred dogs before?  If yes,
give details
Have you ever shown and/or
titled a dog in any venue?  If yes,
give details.
Do you rent or own your place of
residence?
How long have you lived at your
present address?
How often have you moved in the
past 10 years?
Where is the primary place that
this dog/puppy will reside?
How much time will the
dog/puppy be left alone during
the day?
Do you have a fenced in yard?  If not, how do you
propose to handle bathroom duties as well as
required exercise for this dog/puppy?
If your dog/puppy swallowed something that the vet
says will take a $1,500.00 surgery to remove, what
would you do?
Give some details of your family situation.  (ie:
Number of immediate members, ages, lifestyle, etc.)
Would you be willing to have a representative from
Image Aussies visit you for a home check prior to
placing the puppy with you?
No
Yes
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REFERENCES
Veterinarian name, address, and
phone number.
Personal reference name,
address, and phone number.
Personal reference name,
address, and phone number.