NAME:____________________________________________________________

ADDRESS:_________________________________________________________

__________________________________________________________________

HOME PHONE:_______________________________________________________

WORK PHONE:_______________________________________________________

CELL PHONE:_______________________________________________________

EMAIL:____________________________________________________________

Please introduce yourself by answering the following questions. The information you share about yourself, family, home, lifestyle, and most especially your goals for a dog, will help me get to know you and match you with the right litter/puppy. Thank you.

(1) Why do you want a Belgian Shepherd?

(2) Have you ever owned a Belgian Shepherd before? Other Dog(s)? If yes, please elaborate.
If purebred, from whom did you purchase it/them?
Where is/are the dog(s) now? (if deceased, please give age and cause of death).

(3) Do you intend to participate in any of the following with your Belgian Tervuren?

      Conformation:      Obedience:      Agility:      Herding:

      Tracking:      SAR:      Schutzhund:      Other:

(4) How do you intend to obedience train your Belgian Tervuren? On your own? With a club/trainer?

(5) Do you hope to breed Belgian Tervuren? Please explain:

(6) Do you have children at home or visiting at regular intervals? If yes, please list sexes and ages.

(7) Do you have other pets? If yes, please list types and numbers.

(8) Do you or your neighbors have livestock? If yes, how close to your home? Please list types and approximate numbers.

(9) How do you envision a dog fitting into your home (schedule, indoor/outdoor, activities, exercise)?

(10) Where will the dog be while you are away during the day?
How long each day will the dog be alone?

(11) Where will the dog sleep?

(12) Who in your family will be primarily responsible for:
      daily care of the dog?
      clean-up?
      training?
      exercise?

(13) What will you do with the dog when you go on a vacation trip?

(14) When you travel with the dog, where will it ride?

(15) Do you have a fenced yard? If yes, please describe (size, height, type, location):

(16) Do you intend to use a crate for housetraining this puppy?

(17) Do you have a veterinarian you will use?
      Name:
      Clinic Name:
      Address:
      Phone:

(18) Do you belong to any dog clubs? If yes, please list:

(19) Do you have any favorite dog training books? If yes, please list:

(20) What do you expect of your Belgian Tervuren?

(21) What do you expect of your dog breeder?

(22) May I, or my representative visit your home?

(23) Please describe your occupation (so that I can get to know you better).

(24) Please describe any physical or character attributes which are of particular importance to you in the puppy/dog you are seeking at this time.

(25) I am interested in a Male/Female of Show/Performance/Pet-Companion Quality. (Please indicate what best applies. Feel free to elaborate).

      Owner(s):

(26) In the event that you purchase a Montage Belgian, please print the exact spelling of owner's name or names as it should appear on the registration papers:

(27) How did you hear about Montage Belgians?

REFERENCES: (required before a deposit will be accepted, otherwise not needed as part of an introductory email)

Please provide names, addresses and phone numbers of at least three references. These may include dog trainers, Belgian owners, veterinarian, friends or neighbors, anyone who knows you well enough to recommend you as a good dog owner (family members excluded).

Name:____________________________________________________________

      Address:_________________________________________________________

      __________________________________________________________________

      Phone:____________________________________________________________

      Email:____________________________________________________________

      Relationship to you:_______________________________________________

Name:____________________________________________________________

      Address:_________________________________________________________

      __________________________________________________________________

      Phone:____________________________________________________________

      Email:____________________________________________________________

      Relationship to you:_______________________________________________

Name:____________________________________________________________

      Address:_________________________________________________________

      __________________________________________________________________

      Phone:____________________________________________________________

      Email:____________________________________________________________

      Relationship to you:_______________________________________________