Introduction

Introduction

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

*Name:


*Address:


*E-Mail:


*Phone:



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?: