Potential Puppy/Dog Client Information Thank you for your interest in our dogs. We would appreciate your answering the following questions so that we may more easily assist you in selecting the right puppy/dog for your needs. All information is confidential and used only by us at Falkrigia. Thank you for your cooperation.   FULL NAME:  SPOUSES NAME:  E-mail Address:  Address:    State: Select State Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Col. Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virgin Islands Virginia Washington West Virginia Wisconsin Wyoming Country: United States Afghanistan Albania Algeria American Samoa Andorra Angola Anguilla Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia and Herzegovina Botswana Brazil British Virgin Islands Brunei Darussalam Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China Colombia Comoros Congo Cook Islands Costa Rica Croatia Cuba Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands Faroe Islands Fiji Finland France French Guiana French Polynesia Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guatemala Guinea Guinea Bissau Guyana Haiti Honduras Hong Kong Hungary Iceland India Indonesia Iran Iraq Ireland Israel Italy Ivory Coast Jamaica Japan Jordan Kazakhstan Kenya Kiribati Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macau Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mexico Micronesia Moldova Monaco Mongolia Montserrat Morocco Mozambique Myanmar Namibia Nepal Netherlands Netherlands Antilles New Caledonia New Zealand Nicaragua Niger Nigeria Norfolk Island North Korea Northern Mariana Islands Norway Oman Pakistan Palau Panama Papua New Guinea Paraguay Peru Philippines Poland Portugal Puerto Rico Qatar Reunion Romania Russia Rwanda Saint Helena Saint Kitts and Nevis Saint Lucia Saint Pierre and Miquelon Saint Vincent/Grenadines Samoa San Marino Saotome and Principe Saudi Arabia Senegal Seychelles Sierra Leone Singapore Slovak Republic Slovenia Solomon Islands Somalia South Africa South Korea Spain Sri Lanka Sudan Suriname Swaziland Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks and Caicos Islands Uganda Ukraine United Arab Emirates United Kingdom United States US Virgin Islands Uruguay Uzbekistan Vanuatu Vatican Venezuela Vietnam Western Sahara Yemen Yugoslavia Zambia Zimbabwe Zip/Postal Code: Phone (home):      Phone (business): List Ages of Household Members: List other Animals in the household: Type of Animal Desired: adult puppy no preferances male female no preferances Why are you interested in obtaining one of our German Shepherds? companion show obedience protection other What qualities do you like in the GSD? What don't you want to find in a GSD? Is this your first GSD? Yes No Are you willing to spay/neuter this dog? Yes No Do you live in a House Apartment Condo/Co-op Other If you rent, will a GSD be welcomed by your landlord? Yes No Is your yard fenced? Yes No If fenced, type and height Do you and your spouse work? Yes No Full Time Part Time Where will the dog stay during the day? Where will the dog stay at night? Are you familiar with a dog crate? Yes No Do you own a crate Yes No If yes, size of crate: What are the leisure-time activities of the family? How were you referred to us? Submit this form if you are committed to caring for this dog for its lifetime How should we contact you?: Email: Fax Phone: Voice Phone: Snail Mail: