BUYER APPLICATION for the Shaker/Happy Litter ~ upon application approval a $700 nonrefundable deposit to Reserve either a Companion/Pet, or a Show Puppy with co-ownership and breeding stipulations full price $3500..


We appreciate your taking the time to complete and return the following questionnaire.  Detailed information regarding your lifestyle and experience with dogs helps us in selecting the right puppy for you and your family. Please print out and fill in the below form. Select, copy and paste this text into your email and fill in and email to

Name(s): _______________________________________________________________________________

Street Address: __________________________________________________________________________

Mailing Address:  ______________________________________________City: ______________________

State: ___ Zip Code: ______________ Phone: (H) _____________________________ (W)____________

Fax: (H)  ______________ (W) ___________________E-Mail: (H) ________________ (W) ____________

What do you know about Samoyeds and what attracts you to the breed?

How much time can you spend grooming a Samoyed?

Have you ever owned a dog before?  Yes_____No_____Breed(s)

What happened to them?

Do the other members of your family also want to get a puppy?

What other types of animals live in your house?

Have you ever had a dog that died or had a significant health issue?

Have you ever had to put an animal to sleep?      If yes, why?

What is the most important reason(s) for purchasing a Samoyed (check all that apply):
family companion ___ show dog ___  breeding _____  obedience competition ____

agility / fly ball competition____ pet therapy_____  a dog for the kids ____other____________

Have you taken obedience or puppy kindergarten classes with a puppy/dog before?      Where?

Do you prefer a male or female puppy/dog?            Are you willing to spay/neuter this puppy?

If you move, what will happen to this puppy/dog? 

Do you believe in using dog crates?    Yes ___   No____   Why?

Do you have any objections to a home check by us or by a person we designate?  Yes___  No___

How will you feed this puppy/dog?    Free Choice    Once a Day       Twice A Day

Family Profile: 

Please circle:  Married    Single    Divorced    Separated    Widowed    Live w/  parent  or relative    Live w/ other

How long?      years         months                 Do you have plans to move soon?

Your age:           Occupation

Spouse/Partner’s age:        Occupation

Who will get this dog in case of divorce or breakup of relationship?

Number of children in household and/or who visit on a regular basis:          Ages:

Have these kids been exposed to dogs before?   Explain.

If you don't currently have children, are you planning to start a family in the future?

Please circle the type of area you live in:     City     Suburb         Subdivision           Country

Are there covenants, ordinances or other restrictions regarding dogs in your area?         If yes, explain.

Will the puppy/dog be kept: Inside____Outside____In yard____Loose____Kennel Run______

Garage_____   Basement____Other__________________________________________________

Is your yard fenced?  Yes____No____ Fence type and height_______________________________

If you do not have a fenced yard, where and how will the dog be exercised and be allowed to eliminate?

Do you have a swimming pool?    If yes, it is fenced in?

Does your home have air conditioning?      Basement?       Cool garage?         Other

Do you have a deck?     How high off of the ground is it?         Railing?  

Would you object to sending photos of your home and property?

If you rent, do you have written permission from your landlord to have a medium size dog?

Would you mind if we contact your landlord?


Name: ______________________________________________________________________

Address: ______________________________________________  Phone: ___________________

Where will the puppy/dog sleep at night?

Where will the puppy/dog be kept when there is no one at home?

How many hours each day will your puppy be alone while you are at work?

Who will have the major responsibility to care for your puppy/dog?

What will you do if the puppy/dog barks excessively?

How much money do you expect to pay for veterinary care each year?

Do you have a current veterinarian?           

Name/Business Name:  __________________________________________________________                                              

Address: _______________________________________________________________________ 

City: __________________________________ State: ____   Phone:_________________________

Please list one personal reference and one work reference:

Name: ______________________________________________________________________________

Address: ____________________________________________________________________________

City/State  ________________________________     Phone:  __________________________________

E-mail: _____________________________________  Years Known:  _____________________________

Name: ______________________________________________________________________________

Address: ____________________________________________________________________________

City/State  ________________________________     Phone:  __________________________________

E-mail: _____________________________________  Years Known:  _____________________________

Please add other information that would be helpful in placing a puppy with you:

Thank you for your interest in Kingdom Samoyeds.