Full Name (required)

Your occupation (required)

Spouse's Full Name (required)

Spouse's occupation (required)

Address (required)

Own or rent (required)

How long at current address? (required)

Phone number (required)

What type of home do you live in? House, apartment, condo, etc. (required)

Do you have a fenced yard? (required)

What other pets do you own now? Breed? How many? (required)

Does anyone in your house have an allergy to dogs? (required)

Have you ever owned(or had any experience with) a basset hound? (required)

Is everyone in your home committed to the care of a new puppy? (required)

Are you ready to make a new puppy a permanent member of your family?

Your email (required)

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