Puppy Buyer Questionaire

The information you provide on this form will help us understand your specific requirements and allow us to help you select the Golden Retriever puppy that is the best fit for you and your family. Please try to be as accurate and detailed as possible, and answer all questions, If you have problems with any of these questions please feel free to call or e-mail us for advice.

Information you provide to Corbec Farm will only be used to ensure that you receive the best possible puppy for your family. None of the information provided to Corbec Farm will ever be shared with outside parties.

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Be sure to click the Submit button at the bottom of the page after completing the form.

Name: *

Address 1: *

Address 2:

City/Town: *

State: * Zip: * -

Phone Number: *

E-mail Address: *

Do you have any children?


Children's age or ages:
(please check all that apply)

0 to 1
1 to 5
5 to 10
10 to 13
Over 13

Do you currently own any other pets:


Puppy Gender Preference:

No Preference

Why have you decided to purchase a Golden Retriever?
(please check all that apply)

Had Goldens before
Reputation of the breed
Recommendation of others
Vet referral
Result of research about the breed

What activities are you planning to do with this dog?
(please check all that apply)

Competition (field, show, obedience, agility, tracking, etc.)
Athletic (jogging, biking, boating, hiking, camping etc.)
Backyard activities

Select a Personality Preference:

Sensitive, sweet, likes attention
Upbeat, independent, loyal buddy
No preference

Appearance: (size and color)


Medium size
No Preference


Light Golden
Medium Golden
Dark Golden
No preference

Activity Level:

High energy performance dog
Moderate energy
Quiet, laid-back
No preference


No preference

I have answered these questions carefully and understand that the puppy selected will be based on this information.
Date: *

How did you learn about Corbec Farm Golden Retrievers?
Please select all that apply.

Past experience
Recommended by a friend
Internet search
Print ad
Magazine article

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