John and Elaine Cornell

964 Williams Hill Road
Richmond, VT  05477
(802) 434-6393

FAX:  (802) 329-2343









Your Name ______________________________________ Phone ____________________________

Address_________________________________________  Email ____________________________

City      _____________________________________  State___________  Zip______________

Single _______ Married _______ Number of children and ages ____________________________

I/We would like a Male _____ Female _____   No Preference__________

Number of pets owned now __________

Please list type of pets (from above) _______________________________________________________

Have you ever owned a Newfoundland before? _______ If yes please circle: Male / Female

If yes, where did you get the Newfoundland from and describe its role in your life:______________________


List other breeds/mixed breeds you have owned and describe  their role in your life:   ___________________


Do you have a fenced yard? ___________         Approximate size of yard:__________________________

If no, are you opposed to fencing in your yard: ___________ Do you own a crate?____________________

If no, would you be interested in purchasing one? _________

Are you for any reason against spaying or neutering your Newf?___________________________________

If yes, if other than a potential show dog, give reason: ___________________________________________

Please check preference: ________ Companion (pet) on spay/neuter contract

________ Show/Breeding, subject to agreement in sales contract

________ Older rescue & adoption

How did you hear about us? ________________________________________________________

Have you ever had any affiliation with a pet shop or dog broker? _____________________________

Are you willing to attend a good obedience course with your new puppy? ______________________

Have you seen and researched the Newfoundland breed before looking to buy a puppy? ___________

Please list any references you may have and a phone number of your veterinarian below:





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Thank you for filling out this survey, it helps us to understand what your goals are and to better assist you in your search for a Newfoundland dog..