1) Personal Information/Contact Information
First and Last Name: ___________________________________________________________________________
Residence address: ____________________________________________________________________________
Mailing address (if different): _____________________________________________________________________
City, State, Zip, Country: ________________________________________________________________________
Home phone#: ___________________Cell phone#: _____________________Fax#(if any): __________________
Email address: Website address (if any): __________________________
Occupation: _____________________________________________________Work phone #: _________________
How long have you lived at this address? __________ Do you have plans on moving in the next 5 years? Yes No
When is the best time that you can be reached at home? ____________________________________________
How did you find us or hear about Black Mask Rottweilers?
Why are you interested in a Black Mask Rottweilers puppy?
Are you: Married Single What is your age?
(Please give correct and accurate spelling of your address and email. We can not contact you if you do not give us accurate information. If
your mailing address is a PO Box, you must also list your physical address. We can not emphasize this enough.)
2) What breed research have you done before deciding on owning a rottweiler? ___________________
3) Do you have a preference in the sex of the puppy? Male Female No preference
Are you looking for a: Puppy An Older Dog
4) What are your plans for your new puppy?
Conformation showing Schutzhund/protection work
Tracking/search and rescue Herding
Breeding Family pet/companion animal
5) If you are buying this puppy as a show prospect or to obtain working titles on this dog, please tell us about your experience with titling a
dog, if any, and what are your expectations are for this puppy.
6) Have you ever owned a rottweiler before? Yes (*see below) No
(*If yes, please list the breeder(s) you bought your dog(s) from, and their contact information (email address). If deceased, how did the dog
7) Are you willing to spay/neuter this dog? Yes No (If not, why?)
8) If you are purchasing this puppy as a breeding prospect, are you currently breeding rottweilers? If not current, what is your experience
in breeding rottweilers?
9) If you intend on breeding your new rottweiler, what health certifications do you feel are important or necessary prior to breeding?
10) If you are planning on breeding, what are your goals as a rottweiler breeder?
11) Are you willing to have your rottweiler's hips and elbows x-rayed and submitted to OFA (www.offa.org) at 2 years of age. Yes
12) Are you willing to invest time and money to take at least 2 sets of obedience classes with your new rottweiler? If yes, where? If no,
explain why not? ______________________________________________________
13) Do you have any “At Risk Breed” laws or breed specific legislation where you live? Yes No
(Make sure to check city, county, and state laws as well as condo association and homeowners association bi-laws. You can find out about
your city, county, and state laws from you local SPCA. We will also be checking your area prior to placement. Also check with your
homeowners’ insurance policy. Some insurance companies have breed restrictions.)
14) Previously owned dogs other than rottweilers? (give breed and how long you had them, their disposition and any titles you may have
put on them)
15) Do you currently have any other animals living with you? If yes, how many and what kind? _______
16) Do you have any children living with you? If yes, what are their ages? ___________________________
17) Who will be the main caregiver for your new puppy? ____________________________________________
18) Will you be using a crate for you new puppy? Yes No
19) Where will your new rottweiler spend most of its day? Inside outside crate other_____________
20) Where will your new rottweiler be sleeping at night? Inside outside crate other_____________
21) How many hours a day will your new rottweiler be left alone? ____________________________________
22) Do you live in: Urban Suburban Rural (on acreage?, how many?)
23) What kind of home do you live in? (condo, house, apartment, etc.) Approx. how many sq. ft.?
24) Do you own or rent your home? _______________________________________________________________
(If renting, we will need a written approval from your landlord regarding you adopting a rottweiler.)
25) Does your home have a securely fenced yard? How large will the area be for your new rottweiler? Please describe in detail, sq. ft.
and type of fencing. (an underground electrical fencing system is NOT
26) We require a home visit done by ourselves, or a person representing Black Mask Rottweilers, before any dog is placed in a
perspective home. When would be a good time for a home visit?
27) Please list at least 3 personal references (ie. your vet, other breeders, someone that can accurately describe you ability to be a
rottweiler owner). Please include name, phone, email address, and their relationship to you. If you have owned a dog before, the breeder(or
rescue), the veterinarian, a trainer, boarding facility, etc., MUST be one of your references.
a. Name: ________________________________________________________phone: __________________
b. Name: ________________________________________________________phone: __________________
c. Name: ________________________________________________________phone: __________________
28) Have you ever given up a dog or cat to an animal shelter? Yes No If yes, please explain the circumstances and why the animal
was released to the shelter. ________________________________________
At Black Mask Rottweilers, all dogs sold as pet/companion animals will be sold with a “Limited Registration” and a mandatory spay/neuter
clause. Dogs with "Full Registration" will only be sold on a co-ownership until such a time that the required health certifications are passed at
2 years of age in accordance with the American Rottweiler Club's Code of Ethics, at which time full ownership will be released to the buyer.
OR We receive a document of sterilization signed by a licensed veterinarian stating that the dog has been spayed/neutered, at which time full
ownership will be released to the buyer.
29) Do you have any concerns or questions with the above statement?
30) What type and brand of food are you going to be feeding your new rottweiler? ___________________
31) Would you be interested in learning about alternative foods? (Natural, Holistic, Raw diet, etc.)
(Although not required, we do give consideration to those feeding or willing to feed a holistic or raw diet.)
32) Are you willing to travel to pick up your puppy? Yes No
33) Please give us any additional information that you feel will help us choose the appropriate dog for you and why we should choose you
for one of our puppies.
Dear perspective puppy buyer;
Completing this questionnaire in no way guarantees that we will have a dog/puppy for you. It is simply a tool to aid us in finding the most
appropriate homes for all of our available dogs/puppies. It is very important to us, here at Black Mask Rottweilers, that we find the very best
forever homes for all dogs produced or re-homed by us. Please take the time to fill out the questionnaire as completely as possible. This is
only the beginning of the interview process and we will not place any dog/puppy into a home when all communication has been done via email.
We insist on meeting you in person and forming a relationship with you, to even consider placing a puppy with you. We will not give pricing
information via email, so don't ask, and we do not sell guard dogs or personal protection dogs to anyone, for any reason, at any time. If there
are questions that do not apply to you, simply put an n/a in the space provided. We reserve the right, at any time, to refuse any person, for
any reason. As soon as we receive and review your questionnaire, we will be contacting you via phone within a week. If you don't hear back
from us, we did not receive your questionnaire. Please follow up with an email or a phone call. Thank you so much for taking the time to allow
us to get to know you better.
Tracy L. Matty
Black Mask Rottweilers
This questionnaire has been completed truthfully, to the best of my ability, and is therefore submitted for consideration.
Signature of applicant date