KiMar Keeshonden
1080 Hilltop Drive* Duncansville, PA  16635


This application is to provide us with contact information so we can discuss further your interest in a
KiMar Keeshond puppy.  We want to place the best suitable puppy for your family and lifestyle into your
home. Submitting this form does not obligate you to purchase a puppy nor does it guarantee that we
will have a puppy for you at the time.

Zip Code:
Home Phone:
Cell Phone:
Work Phone:
Email Address:
Referred by:

1. Do you prefer a male or female puppy?

2. Do you plan on training and/or competin
g in any of the below events?

0  Obedience
0  Rally
0  Agility
0  Conformation
0  Other, please explain

3. Have you owned prior Keeshonden, if so where were they purchased?
If not, why have you choosen this breed?

4. Do you currently own any other dogs (breed and age)?

5. Is your yard fenced (what kind of fencing), if not how will you provide exercise to puppy?

6.  Do you own or rent your home?

7. Number of adults and children (ages) living in your home.

8. Name and address of your Veterinarian.

Complete application and copy and paste  into email

          Complete, Print and Mail