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. Even if you are a long-time dog person with lots of experience it will still be helpful to me to have the information in this questionnaire. Thank you very much.

(1) Why do you want a Belgian Shepherd?

(2) Please indicate what best applies and feel free to elaborate:   I am interested in a Male/Female for the purpose of Show/Performance/Pet-Companion.

(3) Please describe any physical or character attributes which are of particular importance to you in the puppy/dog you are seeking:

(4) Would you be interested in an older puppy or an adult?

(5) What is your time frame for getting a puppy/dog?

(6) Have you ever owned a Belgian before?

      Please list the registered names including any titles of Belgians you have owned or now own:

      From whom did you purchase the dog(s)?

      Where is the dog(s) now? If deceased please give age and cause of death:

      Have you owned other types of dogs? If yes, please elaborate:

(7) Do you intend to participate in any of the following activities with your dog?

      Conformation:            Obedience:            Agility:            Herding:

      Tracking:            SAR:           Schutzhund:           Other:

(8) How do you intend to obedience train your dog? On your own? With a club/trainer?

      Please list the name of the club and/or trainer if you have one:

(9) Do you hope to breed Belgians? If yes, please explain:

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

(11) Do you have other pets now? If yes, please list types and numbers:

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

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

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

(15) Where will the dog sleep?

(16) Who in your family will be primarily responsible for daily care, clean up, exercise?

      Who will be the person doing the training?

(17) What will you do with your dog when you go on a vacation?

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

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

(20) Do you intend to use a crate for housetraining your puppy?

(21) Do you have a veterinarian you will use?

      Veterinarian:
      Clinic:
      Address:
      Phone:

(22) Do you belong to any dog clubs?

(23) Do you have any favorite dog training books?

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

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

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

(27) Please describe your occupation (so that I can get to know you better):

(28) 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:

      Owner(s):

(29) 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, phone numbers and email addresses of at least three references.
These may include dog trainers, Belgian owners, veterinarian, friends or neighbors who would be able to recommend you as a home for a Montage puppy/dog.

Name:____________________________________________________________

      Address:_________________________________________________________

      __________________________________________________________________

      Phone:____________________________________________________________

      Email:____________________________________________________________

      Relationship to you:_______________________________________________

Name:____________________________________________________________

      Address:_________________________________________________________

      __________________________________________________________________

      Phone:____________________________________________________________

      Email:____________________________________________________________

      Relationship to you:_______________________________________________

Name:____________________________________________________________

      Address:_________________________________________________________

      __________________________________________________________________

      Phone:____________________________________________________________

      Email:____________________________________________________________

      Relationship to you:_______________________________________________