Name/Both if married _______________________________________________

Street _____________________ City ____________________ State ____

Zip ________

Home Phone____________ Work Phone____________________

Cell Phone____________________ Best time to phone you if necessary ______

Email ___________________________________________________________

How do you prefer to be contacted? Phone _____ or Email ______

Do you currently have a veterinarian?   ____Yes  ____No

If no, what are your plans for finding a vet?_____________________

________________________________________________________

May we contact your veterinarian for a reference?  ____Yes  ____No

Veterinarian name _________________________________________

Address ___________________ City _________________ St _____ Zip _____________ Phone____________________

How did you hear about Bengalskaya Cattery? ________________________________

Do you live in a house____ Apartment _____ Condo_____ Country____.

Do you own or rent?____________________________________

If you have children living at home, what are their ages? _____________________

Does anyone in your home have allergies? If so, please tell us about their allergies._______________________________________________________________

_______________________________________________________________________

Please tell us about the special needs of anyone in your household. ___________

_______________________________________________________________________

Please tell us about your family life and life style. ____________________________

_______________________________________________________________________

Have you ever owned and raised a kitten? If so, please tell us about your experience. ____________________________________________________________

_______________________________________________________________________

Does everyone in your home want a kitten?  _______________________________

Do you have other pets at home? If so, please tell us about them.  ____________

_______________________________________________________________________

Do you have a cat now? ___________

What arrangements will you make for your kitten when you are at work or away from home? ____________________________________________________________

________________________________________________________________________

Where will your kitten sleep at night? ______________________________________

Have you ever had to place a pet in a shelter? If so, please tell us when and why.

________________________________________________________________________________________________________________________________________________

Should you find yourself unable to care for your kitten at any point in time, we request that you notify us so that we may assist you in re-homing the cat/kitten. Do you agree to this? YES ____NO _____

Have you ever had a pet put to sleep? If so, please tell us when and why. ________________________________________________________________________________________________________________________________________________

Would you like to tell us anything else or provide any other information you would like us to have, or consider? _____________________________________________________________________________________________________________

________________________________________________________________________________________

Mail completed application to: Darby or Wendy Sanders, 1045 Oak Road, Harlan, IA 51537

Date of Application: __________________

Thank you!