Moonlight Shibas Puppy Questionnaire

Thank you for your interest in Moonlight Shibas and for taking the time to answer the following questions:
Date*

MonthDayYear
Date
Name*

First NameLast Name
Occupation*
Spouse (if applicable)

First NameLast Name
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Email*
example@example.com
If you have children living at home: names (optional) and ages
Does anyone else reside in your home? *
If yes, who and are they permanent residents or temporary.
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Years at this address:*
Is this home*
Explain if owned by other:
Type of structure*
YesNo
Where will your shiba spend a majority of its time during the day? and at night?*
YesNo
YesNo
If yes please provide breed/species, name, age, spay/neuter status
Have you previously owned dogs?, where are they now?*
Veterinarian
If you have a veterinarian already please provide the following:*
If you do not have a veterinarian already its very important to find a vet that deals with young puppies and is reputable. Talk to friends and neighbors to see where the best vet in your area is.
YesNo
YesNo
Why do you want a shiba?*
Have you ever owned a shiba? If yes please share. *
If you have not owned a shiba, what sort of research have you done on the Shiba Inu
YesNo
Do you have any questions about the above?
If you have previously participated in an obedience training class please provide instructor name/ class provider and type of class.
YesNoMaybe
I/we the undersigned agree that the information provided herein is accurate to the best of my/our knowledge. I/we are aware that the decision to sell me/us a shiba results from the information provided herein. I/we are also aware that providing misinformation on this questionnaire may result in Moonlight Shibas exercising their right to reclaim the shiba with no monies refunded to the buyer.
Signature*
Signature
Should be Empty:

Thank you for your interest in Moonlight Shibas and for taking the time to answer the following questions:

Veterinarian