Noras Ark Dachshund Rescue Questionnaire

We need to know a little about you



Please fill out the following form completely to be a Dachshund family candidate!

General Information: 

First Name:    Last Name: 
City: State: Zip:   

Telephone:  Work Telephone:  

E-mail:      Best Time To Reach:

years of doxie experience: 
(Breeders Only)
Tax Number/license number:
if known

Reason for wanting a Dachshund: 
Pet     breeding   companion   Childrens pet    showdog   protection
Other reason:    (if applicable)

Income Level: 
Up to 25,00025,000-35,000 35,000-45,000 45,000-55,000 55,000-65,000 65,000-75,000 75,000-85,000 85,000-100,000 Bill Gates

What Payment service/Credit Do You Prefer?  (select all that apply)(optional)
Paypal Billpoint check/money order Direct Deposit Wampum or other

Check if you have any if the following  (select all that apply)
All child husband wife other other dogs Home business kennel area outdoor doghouse Fence yard other livestock