To Better Serve You Please Fill Out This Form before Making Your Appointment and Return It to Icewind Farm

Name: Phone:

Address: Cell:

Email:

Names & Occupations of All People Living In Your Home:

Name: Age: Occupation:

Name: Age: Occupation:

Name: Age: Occupation:

1. Will someone be home during the day? Yes Or No

2. Are you willing to crate the puppy in your bedroom for housetraining and block off your kitchen during the day? Yes or No

3. Explain how & who will care for your puppy?

4. How will you be exercising your puppy?

5. What color are you looking for? Red Red Sesame Black & Tan Cream

6. Male or Female

7. Explain your knowledge of the Shiba Inu?

8. List all pets you have or have had:

9. Are you willing to keep your puppy on the diet he/she is use to eating? Yes or No

10. Great knowledge & care goes into choosing Shiba puppy supplies, Are you willing to buy the supplies needed for your puppy from Anya’s pet store? Yes or No

11. If no answer please explain why?

12. Are you willing to donate to Shiba rescue? Yes or No

13. If no please explain why?

14. Are you willing to attend puppy socializing classes? Yes or No

15. If no please explain why?

16. How much time will you need for your appointment?

Thank you this form will help us make your visit a pleasant and informative one.

Cheers! Karen & Anya

Three ways To Send:

1. Email gwmoore3@msn.com

2. Fax (908)475-8099

3. Phone (908)475-8945 Ask For Anya or Karen

We do offer a lifetime guarantee with your cooperation.