PERSONAL INFORMATION
Your Name (First, Last):
Spouse's Name (if any):
Home Address:
Address2 (if appl.)
City:
State,  Zip:
Home Phone:
Cell Phone:
Work Phone:
Email Address:
Work Email Address (if permitted):
How many adults live in your home?	Choose One 1 2 3 4 5+
How many children live in your home?	Choose One 0 1 2 3 4 5+
If you have children, what are their ages?
RESIDENCY INFORMATION:
Type of Home:	Choose One House Condo/Townhouse Apartment Mobile Home / Trailer Other
If other, please describe:
Do you Own or Rent?	Choose One Own Rent
If you rent, do you have permission to have large dogs?	Choose One Yes No
What type of fence do you have?	Choose One Block Wall Privacy Wood Picket Wood Chain Link Other No Fence
If other, please describe:
What height is your fence?	Choose One Below 4 Feet 4 to 5 Feet 6 Feet or taller N/A-No Fence
PET AND PET CARE INFORMATION:
Do you currently own any dogs?	Choose One Yes No
If "Yes", how many?	Choose One 1 2 3 4+
Please describe your current dogs (Breed, Age, Gender):
Do you currently own any other pets?	Choose One Yes No
If "Yes", please describe:
Have you ever owned a Great Dane?	Choose One Yes No
Do you prefer a Male or Female:	Choose One Male Female
Do you prefer a certain color?	Choose One No Preference Harlequin Mantle Brindle Merle Fawn Black Blue White
Please specify an age range you prefer:	Choose One Puppy (8 weeks to 1 year) Adolescent (1 to 2 years) Adult (2 to 5 years) Senior (5 years plus)
Where will your Great Dane stay during the day while you are away?
Where will your Great Dane sleep at night?
Where will your Great Dane go while you are on vacation?
Do you currently have a Veterinarian?	Choose One Yes No
If "Yes", please provide your Veterinarian information:
Vet / Clinic Name:
Address:
City, State, Zip:
Vet's Phone Number:
PERSONAL REFERENCE INFORMATION:
Please provide 2 personal references:
Name 1:	Phone Number:
Name 2:	Phone Number:
Additional Comments or Questions: