Samburu Basenjis
P.O. Box 675
Clackamas, Oregon 97015
(503) 653-5540
Thank you for your interest in Samburu Basenjis. We would appreciate it if you would
answer the following questions so that we can determine whether a basenji is the right
dog for you. All information is kept confidential and is for our use only. Thank you for
considering one of our dogs, and for your help in answering the questions below.
Phone Number - Alternate:
When is a good time to reach you by phone?
If so, what are their ages?
How did you find out about us?
What type of dog are you interested in? (Check all that apply.)
Do you have a color preference? (Please number 1-5 in order of preference.)
Black, Tan & White (tri-color)
What do you plan to do with your basenji? (Check all that apply.)
What qualities do you like in the basenji breed?
What qualities don't you want to find in a basenji?
Is this your first basenji?
Have you had a dog previously?
If yes, which breed(s) did you have?
What happened to dogs previously owned?
Do you presently have animals?
Where will the dog sleep at night?
Where will the dog stay during the day?
Do you have a fenced yard?
Did you know that basenjis can climb and/or jump fences?
How would you plan to prevent your basenji from escaping?
Are you familiar with crate training?
If yes, do you agree with or oppose it?
Do you currently have a veterinarian?
How much do you expect to pay for a basenji?
Please provide us with names & phone numbers of any references we may contact:
Please use the space below to let us know what you expect from owning a basenji.
Thank you for completing our application. All information will be kept strictly confidential. If you have questions, please feel free to contact us at (503) 653-5540. We look forward to hearing from you.
Copyright 2009 SAMBURU BASENJIS
