* Address:

* City, State, Zip:

Are you looking for a long, wire or smooth coat dachshund? Please state which one(s) in your answer.

Male or Female?

Miniature, Tweenie or Standard? Please state which one(s) if you have a preference.

Do you have a color or pattern preference?
Yes llllllll No

If yes, please state desired coat color/pattern.

* Are you interested in a companion or a breeding/show prospect?

* Have you ever owned a dachshund before?
Yes llllllll No

If yes, how many and when?

Would you like additional information regarding dachshunds?
Yes llllllll No

* Is the puppy/dog allowed on the furniture? (couches, beds, etc.)
Yes llllllll No

If no, what are you reasons?

* Is everyone in your family aware of the possible addition of a dachshund to your family?
Yes llllllll No

If no, who is unaware and why?

* Do you have children? (Please be aware that dachshunds are not ideal for most families with children younger than 5 years of age.)
Yes llllllll No

If yes, what are their ages?

* Do you work?
Yes llllllll No

If yes, where is the puppy kept during work hours?

If you work, how many hours per day are you out of the home?

If you work, is anyone available during your work hours to exercise the puppy?
Yes llllllll No

* Are your pets kept inside or outside the majority of the time?

* What type of dwelling do you currently reside in? (i.e. house, condo, apartment, mobile home)

* Do you have a yard or other outside play area?
Yes llllllll No

If yes, is it fenced?
Yes llllllll No

* Where will this puppy sleep?

* Have you ever returned a pet to its breeder, taken a pet to the humane society or given it away?
Yes llllllll No

If yes, what were the circumstances?

* Who takes care of your pets while you travel?

* References: (Please provide at least 3 references and have a vet as one of them if you have previously or currently owned/own a pet.)