Jackie Simonds
 Home 920-261-2846 Cell 920-248-6298
jsimonds@charter.net



Contact Us
Puppy Information Questionnaire
Concerned Father & Mother: 
Only want the best for their Puppies


1.  Your Name (Required):



2.  Your Street Address (Required):



3.  Your City, Province/State and Postal Code/Zip (Required):



4.  Your E-Mail Address (Required):







5.   Phone # (Optional): 



6.   How did you find us?  (Breeder Directory, Another buyer, etc.):




7.   Do you have any dogs or other pets at this time and please list them:




8.   Do you have Children?



9. If you are interested in breeding, please state your experience:







10.  Do you own a Mi-Ki now?  What registry is it registered in?  




11.  Do you want:








12. Please feel free to ask us questions?










Thank you for taking the time to fill out this questionnaire 
so we can get to know you.

  RAINBOW'S END MI-KIS
.



YesNo
Male (pet)
Female (pet)
Male (breeding/showing prospect)
Female (breeding/showing prospect)