If you are interested in a Pacifica Cane Corso, please take a few minutes and submit the application below. We sell our pups to approved homes only, so we appreciate you taking the time to help us get to know you better. Filling out this application does not obligate you to buy a puppy nor does it guarantee you will be approved. We will contact you after we review your application. Please be honest - there are no "right" or "wrong" answers, and please take the time to fill out the application completly. The information you provide will allow is to get to know you better, and help us to match the right puppy to your family.

Your Name:
 Your eMail Address:   *Required Field*
Day Phone Number:
 Evening Phone Number:
 Cell Phone Number:
Street Address:
 City, State/Provence, Zip:
Are you at least 18 years of age and able to enter into a legal agreement? Yes No
Do you have a spouse or significant other? (If yes, provide name/relationship)
Do you have Children in your home or as frequent visitors?
(If yes, provide Name / Age / Relationship for each one)
Do you have other Adults in your home or as frequent visitors?
(If yes, provide Name / Age / Relationship for each one)
Please list all pets that you currently own and/or care for:
(Please provide the following for each pet: Breed / Age / Sex / Spayed/Neutered or Intact?)
Do you Own / Rent your House / Townhouse / Condo / Apartment / Other
How long have you lived at this residence? Do you have any plans to move soon?
Is your yard fenced? (Please provide details on the fence type and height)
Please indicate the size of your home and yard.
Will your dog live primarily Inside or Outside your home?
Provide details on shelter provided outside, and/or access your dog will have inside house.
(Full run of house, restricted areas of house, etc)
Will there be anyone home on a regular basis during the day? (Provide details)
How many hours per day will your dog spend alone? (Provide details)
Have you owned a dog before?
 		Yes No
Provide details on each of the previous dogs you have owned.
(Include each dog's breed and what happened to them or why you no longer have them)
Have you ever surrendered a dog (to a pound / humane society / rescue group / etc.) for any reason?
(If yes, what was the reason?)
Have you ever earned any titles with dogs? (If yes, please give brief description.)
Have you ever bred a litter of dogs? (If yes, give a brief description.)
What type of canine training experience do you have?
Do you have a trainer that you currently use or have used in the past? (If yes, who?)
Do you plan to crate-train your new puppy?
 		Yes No
Puppies need to be trained. They will not automatically know how you want them to behave.
Do you realize this and are you willing to commit to working through behavioral problems?
 		Yes No
Are you willing to take your new Cane Corso puppy thru a puppy kindergarten class
and a basic obedience class with a certified trainer?
 		Yes No
Are you intrested in a
Male Female Undecided
Are you intrested in a
Companion/Pet Show Prospect Working Prospect
Do you have a color preference? (List up to three, in order of preference)
Are you flexible on color preference? Yes No
What kind of temperament are you looking for in your new Cane Corso?

What activities do you wish/plan to participate in with your new Cane Corso?

(Please select all that apply)
 Family Pet      Family Protection     Guard Dog    Conformation Showing
Sport of Personal Protection     Schutzhund     Obedience     Agility
Weight Pulling     Breeding     Other:

Please tell us why you would like to add a Pacifica Cane Corso to your family:
Please give us any other additional information about yourself that will help us determine the best match for you and your family:
Do you have any additional questions or comments for us?:
Provide Your Current Veterinarian Information:
Provide a Personal Reference that is familiar with you and your animals:
How did you find our website? Search Engine / Website Link / Referral / etc. (Please tell us Who!)

Again, please be honest - there are no "right" or "wrong" answers. The information you provide will allow is to get to know you better, and help us to match the right puppy to your family. Intentionaly providing false information on this application will result in denial and loss of your deposit. We do reserve the right to verify all information provided, possibly including a visit to your home. By submitting this application, you are certifying that all of your answers are true and that you have read and understand the information on our policies page.
Do you understand and agree to this?   Yes     No

If you have checked "Yes" above, type your full name in the box below to show you understand and agree to the above terms:

Please double check before submitting that your e-mail address is correct
and you have filled out the application completely. THANKS!



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Website & Design Copyright 2007
About Time Design & Pacifica Cane Corso
All Rights Reserved
Mike Druker, Bonsall CA
MDruker@PacificaCaneCorso.com
H) 760.297.1499   C) 760.613.5376