Introduction Form

If you are interested in a Puppy or Adult Basenji, then I would like to help you find the companion that will fit with your family and activities. Please introduce yourself to me by filling out this form. (Required fields preceded by *)

Contact Information





Household Information

How many Adults and children (provide ages) live in the household?:

Do children visit regularly?:

List all the pets in the household. Include species or breed, age, sex, intact or fixed (neutered or spayed), and how long you've owned:

Do you live in a:

Do you have a Yard?:

Is your household:

Does anyone in the household have pet-related allergies?:

About You

How did you hear about Dibu Basenjis?:

I have...:

What experience or knowledge do have about Basenjis?:

Tell me why you are interested in Basenjis?:

What do you want a Basenji for? (check all that apply):

What type of Basenji are you looking to acquire?

What Age?:

What Sex?:

What color do you prefer?:

If I am unable to provide you a Basenji or I have none available, then can I forward your information to another breeder who might have a Basenji available?: