Please enable JavaScript in your browser to complete this form.Name *Phone Number *AddressCityState *Select StateOther / Outside US / N/AAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinois IndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontana NebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvania Rhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingEmail *What color(s)/pattern are you interested in? *Tri (Black, Red, and White)BrindleRed/WhiteBlack/WhiteHave you had a purebred basenji in the past? *YesNoDo you participate/compete in any AKC sporting events? If so, which? *(agility / conformation / obedience / coursing, etc.)What age range are you looking for? *What gender(s) are you looking for? *MaleFemaleWhat are you interested in for this basenji and why? *What do you like most about the breed? *What pets are currently in the home? *(please list ages as well as kinds and genders)What prior pets are no longer in the home?(please include where they went as well)What type of home do you have? *(house, apartment, condo, etc.)What kind of yard do you have? *(please include information about water features and fencing)What's your daily schedule look like? *(please include information about how long the dog would be left at home alone and if it’s consistent schedule vs ad hoc)How many people live at the house? *(please include ages and experience with animals)Other(please include any additional information you’d like us to consider)How did you hear about/come across Chaverim Basenjis? *WebsiteSubmit