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Submission of #date#

#time#

Name:   #name#

E-mail Address:   #email#

Street Address:   #street#

City/State/Zip:   #city#

Home Phone:   #phone#

Business Phone:   #bphone#

Age:   #age#

# of other adults in household:   #adults#

# of children and their ages:   #children#

How many hrs per day dog left alone:   #alone#

Potty @ lunch or dog walker if more than 6 hrs alone:   #potty#

Location of dog when home alone:   #location#

Location of dog at night:   #nights#

What they would do if coudn't keep dog:   #unable#

Dogs presently owned:   #anydogs#

Dog breeds presently owned:   #breeds#

Any other pets owned:   #pets#

Previous problems with dogs:   #problems#

Previous obedience class experience:   #obedience#

Plan on taking new puppy to obedience:   #class#

Ever owned an ECS before:   #before#

If yes, where did they get the ECS:   #purchase#

Reasons for choosing an ECS if never owned one before:   #reasons#

When do they want the new dog:   #when#

What traits they are looking for:   #traits#

What sex do they want:   #sex#

Would they consider either sex:   #either#

What color do the want:   #color#

Would they consider another color:   #another#

Would they consider an older dog/puppy:   #older#

Maximum age:   #maxage#

Do they rent or own home:   #residence#

Is their yard fenced or have fenced enclosure:   #fenced#

If no fence, how will they control dog:   #controlling#

How much exercise:   #exercise#

How long to housebreak:   #housebreaking#

Where will the dog spend most of it's time:   #where#

Primary reason for wanting a dog:   #wanting#

Explain if other:   #other#

Do they have a vet:   #vet#

Vet's name & phone:   #vetphone#