Name:

Address:

Phone:            Home:            Work:            Cell:

Email:

How did you hear about Merrimac Dobermans?

How many Dobermans have you personally known?

Type of dwelling:    (  ) House    (  ) Condo    (  ) Apartment    (  ) Mobile home

Do you:    (  ) Own?    (  ) Rent?

If renting, please give name, address, phone number, and email of landlord:

Are there any bylaws, covenants, or other restrictions on dogs where you live?

If yes, please explain:

Does your homeowner insurance company have any restrictions concerning owning a Doberman?

How long have you lived at your present address?

Are you planning a move in the near future?    (  ) Yes    (  ) No

If so, when?

Are you:    (  ) Single    (  ) Married    (  ) In a long-term relationship

Are you military?    (  ) Yes    (  ) No

Employer:

Employer Phone Number:

How long have you been employed there?

Number of adults in the home:

Number of children in the home or who may visit often:

Ages of the children:

What experience have the children had with dogs?

Does anyone in your household have pet allergies?    (  ) Yes    (  ) No

If yes, who?

Names and phone numbers of three non-relative references who do not reside in the same household:

1.

2.

3.

Do you have an established veterinarian?    (  ) Yes    (  ) No

If so, please list name, phone number, and address:

Have you owned a Doberman before?    (  ) Yes    (  ) No

Other dog breeds? 

Please tell us about your experiences with other dogs:

How long did you have your previous dog(s)?

Were they spayed or neutered?

Did your previous dog(s) live their entire life with you?    (  ) Yes    (  ) No

If not, please explain: 

Please list all other animals you currently have in your home:

What is your reason for wanting to purchase a Doberman? 

Any color preference? 

Prefer male or female?

Do you have a specific reason why you would prefer a male/female? If so, please explain: 

Are you looking for any specific personality traits?

What activities do you want to participate in? (Please check all that apply.)

(  ) Breeding        (  ) Rally        (  ) Agility        (  ) House pet/Companion        (  ) Therapy work        (  ) Conformation shows        (  ) Obedience        (  ) Flyball        (  ) Companion for other pets        (  ) For the children 

Have you ever earned AKC or other titles on a dog?    (  ) Yes    (  ) No

If so, please explain: 

Is this Doberman to be a gift?    (  ) Yes    (  ) No        For whom? 

Where and with whom will your Doberman be in the following situations?

When you are at home?

When you are at work?

When you are on vacation or out of town?

At night?  

Who will be the primary caregiver?  

Do you use a crate?    (  ) Yes    (  ) No

Any objections to crate training?

Do you have a fenced yard?    (  ) Yes    (  ) No

Gates with locks/latches?    (  ) Yes    (  ) No 

Please describe your house and yard area to be used for the dog: 

Do you have a daily plan for providing your Doberman with exercise?    (  ) Yes    (  ) No 

Would you be willing to allow me to visit your home?    (  ) Yes    (  ) No

All Merrimac Dobermans sold as companions only, (non conformation show) are required to be spayed/neutered and are sold on a limited (non breeding) registration.
Are you agreeable to this?    (  ) Yes    (  ) No 

Do you agree to return your Doberman to me in the event that you are unable to keep the dog for any reason?    (  ) Yes    (  ) No 

Do you agree to keep in contact with me, Nikki McClendon, throughout the life of the dog?    (  ) Yes    (  ) No 

Thank you for completing this questionnaire.  It is important to get to know you in order to make the best possible placement for our Dobermans.  Once your information is verified and there are puppies available you will be contacted.  If we do no have any litters available or you are not quite ready for a dog, we will gladly put you on our waiting list and notify you when future litters and/or adults become available.