Thank you for your interest in a Blue Chip Dalmatian! By filling out this questionnaire as completely as possible, you will help us find the right dog for you. Please note that this form is not a reservation or guarantee of a puppy or dog. We reserve the right to make the final decision on the sale or transfer of puppies and dogs.


Full Name:
Street Address:
City, State, Zip:
Phone (Home/Work):
Email Address:


How did you hear of Blue Chip Dals?  Shows   Breeder  Ad  Web  Other

What age Dalmatian are you interested in?  Puppy  Adult  Any

What sex Dalmatian are you interested in?  Male  Female  Any

What color Dalmatian are you interested in?  Black Liver  Any

What activities will your Dalmatian be involved in?
Pet  Conformation  Obedience  Performance  Breeding

Have you ever owned a Dalmatian? Yes  No  

Do you have other dogs now? Yes  No
If yes, what breed(s)?

What environment will your Dalmatian live in? Inside Outside Both

Describe facilities for housing a dog (fence, yard, shade, dog door, etc...):

How will you exercise your Dalmatian?:

How long, on average, will the dog be alone during the work day?

How old are any children who will be in contact with the dog?

Does anyone in your family have allergies?     Yes  No

What is your time frame for getting a Dalmatian?   

Please add any questions or comments: