Michele Petersen
7300 Nature Lane  Columbia, MO  65202  573.874.0987

This form is designed to help us place the right puppy with the right owner. Your assistance in filling out this form will help us to make the best choices for you and for our pups. All the information included is confidential and is for use in placing puppies only. Thank you for taking the time to provide us with this information.

We are dedicated to our dogs and to our puppies, and we want new owners to be happy and proud of their new puppy, too. Please complete and return this questionnaire, along with any questions you might have for us -- there is space at the end of this form provided for questions or comments.
Email Address:
How were you referred to us?
Number of household adults & children
Do all household members want an Akita?
What will the living environment be for your Akita? Please describe planned housing as completely as possible beyond inside or outside.
Do you have a securely fenced yard? If so, please describe height and nature of fencing.
Do you have any other pets now? If so please state them.
Have you previously owned an Akita or other dogs? Please describe.
Companion or show quality?
Are you willing to crate train?
Are you willing to obedience train?
What personality are you looking for in a dog?
What traits don't you like in a dog?
Do you have a color preference?
Male or female or no preference?
Are committed and prepared to take care of the dog for its entire life?
Name, address, phone of veterinarian reference.

Date and signature (full name is fine)

Lastly, please be sure to click on the submit button below. Thank you!

Name, address and phone number (cell if you wish).
Use the space below for any questions and/or comments for us.

CompanionShow quality
MaleFemaleNo preference