Pet Seller Complaint Form
http://www.humanesociety.org/issues/puppy_mills/qa/puppy_mill_FAQs.html#I_think_my_local_pet_store_might_be_sell
Provided by The Humane Society of the United States
Date __________________
Please attach all documentation related to your dog, including breeder papers, medical records, kennel club registry papers, legal documents, and anything else that pertains to your complaint.
I. Contact Information _____________________________________________________________________________
Prefix (Ms, Miss, Mrs., Mr.) First Name Middle Initial Last Name
_____________________________________________________________________________ Street Address City State Zip Code
_____________________________________________________________________________ Daytime Phone Number Email Address
II. Dog Information Dog’s Name ________________________________
_____________________________________________________________________________ Date of Purchase Age when obtained Breed Sex
Please check one of the following. The dog was purchased: □ Directly from a Breeder □ Over the Internet □ From a Pet Store □ Other_________________ Was your dog altered (spayed/neutered) by the breeder or pet store? □ Yes □ No Was your dog altered by you? □ Yes □ No If yes, at what age? _______ Were you required by the pet shop/breeder to use their veterinarian in order to comply with a
guarantee or warranty? Did your veterinarian issue a “Not Fit to Sell” certificate upon examining your dog? Were you advised of veterinary care your dog had received prior to purchase?
□ Yes □ Yes □ Yes
□ No □ No □ No
If yes, please explain. Please note if information was received verbally or in writing. Please be specific. Use the back of this page or attach additional pages if necessary. _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________
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Pet Seller Complaint Form
Provided by The Humane Society of the United States
Please describe your dog’s condition upon arrival/pick up. Use the back of this page or attach additional pages if necessary. _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________
How soon after purchase did you take your dog to a veterinarian to be examined? _____________________________________________________________________________
Was it your regular veterinarian, emergency vet clinic, or one referred to you by the pet shop/breeder?
_____________________________________________________________________________
Was the vet visit for health exam/vaccinations or because of medical concerns? Please be specific. _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________
At what point did you first notice your dog may be suffering from medical problems? Please be specific. _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________
Is your dog currently living? □ Yes □ No
If no, please explain how he or she died. Please be specific. _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________
If no, how old was your dog at the age of death? ___________________ weeks / months / years
Were there any prior medical conditions you were aware of upon purchasing your dog? □Yes □ No
If yes, please explain. _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________
2|Page Property of The Humane Society of the United States, June 2010, humanesociety.org/puppymills
Pet Seller Complaint Form
Provided by The Humane Society of the United States
III. Breeder Information - Please provide as much information about the breeder as possible. Attach additional pages if necessary. If you purchased your dog form a pet store, please be sure to fill out Section IV.
_____________________________________________________________________________ Name of Kennel/Facility/Business Breeder’s Name
_____________________________________________________________________________ Street Address City State Zip Code
_____________________________________________________________________________ Phone Number Website Address
How did your dog arrive at your home? Please be specific: air shipped, picked up, driven, etc. _____________________________________________________________________________
How did you learn about the breeder? Please be specific: Internet (please provide website address), newspaper (please identify name and date of newspaper), friend, sign, etc.
_____________________________________________________________________________ If you purchased your dog over the Internet, how was the dog paid for? _____________________________________________________________________________
Was there an interview before you were allowed to purchase your dog? Did the breeder provide references? If yes, did you contact those references?
□ Yes □No □ Yes □No □ Yes □No
If yes, how were the references’ overall reaction/response? _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________
□ Yes □No □ Yes □No □ Yes □No □ Yes □No □ Yes □No
Is the breeder registered with a “kennel club” [e.g. American Kennel Club (AKC), United Club (UKC), Canadian Kennel Club (CKC), etc]?
If so, which one? __________________________________ Did the breeder provide you with registry papers for your dog?
Did the breeder provide you with medical records for your dog? Did you sign a contract with the breeder? Were you advised of any health guarantees for your dog? If yes, were they supplied in writing?
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Kennel □Yes □No
Pet Seller Complaint Form
Provided by The Humane Society of the United States
Were you told of any state law protecting you as a consumer? Did you request to tour the breeder’s home/facility? If yes, were you given a tour?
□ Yes □No □ Yes □No □ Yes □No
Were there specific concerns you had when touring the facility? (e.g. areas you were refused access to) If yes, please explain: _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________
IV. Pet Store Information - complete this section only if your dog was purchased from a pet store
_____________________________________________________________________________ Pet Store Name
_____________________________________________________________________________ Name of Store Manager Name of Sales Person who Assisted You
_____________________________________________________________________________ Street Address City State Zip Code
_____________________________________________________________________________ Phone Number Website Address
How did you learn about the pet store? Please be specific: Internet (please provide website address), newspaper (please identify name and date of newspaper), friend, sign, etc.
________________________________________________________________
Did your dog leave with you on the day of purchase? □ Yes □ No
Did the pet store provide you with transfer documents/breeder papers/etc. listing the name of the breeder/broker who provided your dog? □ Yes □ No
(if yes, please attach) Did the pet store provide you with kennel club registry papers for your dog (e.g. American Kennel
Club (AKC), United Kennel Club (UKC), Canadian Kennel Club (CKC), etc.)? (if yes, please attach)
If so, which one? ___________________________________________ Did the pet store provide you with medical records for your dog? Did you sign a contract with the pet store?
□ Yes □No
□ Yes □No □Yes □No
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□ Yes □No
Pet Seller Complaint Form
Provided by The Humane Society of the United States
Were you advised of any health guarantees for your dog? If yes, were they supplied in writing? Were you told of any state law protecting you as a consumer? Does the pet store also sell other pets (cats, fish, birds, rodents)?
□Yes □ Yes □ Yes □ Yes
□No □No □No □ No
V. Additional Contacts The Humane Society of the United States sometimes works with national and local media outlets
or other organizations to help spread the word about puppy mills and related issues.
Would you be interested in being contacted if we find an opportunity to share your story with the press or other parties?
□ Yes □ No □ Maybe
Please specify restrictions (i.e. no radio, print press only, etc). _____________________________________________________________________________ _____________________________________________________________________________
Have you contacted any other organizations, groups, or professionals about your complaint? □ Yes □ No
If yes, please list the persons or agencies you contacted. _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________
Have you contacted a lawyer? □ Yes □ No If yes, please provide your lawyer’s contact information: ____________________________________________________________
Please include any additional relevant remarks or information you would like to provide below. Please attach extra pages if necessary. _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________
5|Page Property of The Humane Society of the United States, June 2010, humanesociety.org/puppymills
Pet Seller Complaint Form
Provided by The Humane Society of the United States
VI. Certification I certify that the above information is correct to the best of my knowledge.
_____________________________________________________________________________ Name Signature Date
Please attach all documentation related to your dog, including breeder papers, medical records, kennel club registry papers, legal documents, and anything else that pertains to your complaint. If you have photos stored digitally, please email them to stoppuppymills@humanesociety.org and note in the subject your last name and your dog’s name.
Thank you. We really appreciate you sharing your information with us to help in the fight against puppy mills.
VII. Further Instruction Once this form is complete and additional documents have been attached make six copies of
your packet.
- Send one copy to: The Humane Society of the United States, Puppy Mills Campaign 2100 L Street NW, Washington, DC 20037
- Send one copy to the Department of Agriculture for the state where the breeder does business.
- Send one copy each to the Attorney General of the state in which the breeder resides and to the Attorney General in your state.
- Send one copy to the Better Business Bureau. - Save one copy and all originals for your records.
Contact information for state agencies should be in your phone book and on the Internet. Information for the Better Business Bureau should be available in your phone book or at
www.bbb.org.
The Humane Society of the United States (HSUS) works toward a humane and sustainable world for all animals, including people, through public education, legislation, public policy change, hands-on programs, and more, and is the nation's largest animal protection organization with over eleven million members and constituents.
While The HSUS will do what it can to help you resolve your complaint, we cannot promise that an outcome will be what you hope for. The HSUS is not a law enforcement agency, nor a legal firm, but rather an organization dedicated to using its resources to help advance the cause of animal welfare across the globe.
Due to the large volume of breeder complaints received by The HSUS on a daily basis, we cannot guarantee a response within a certain time period, although every effort will be made to respond in a timely fashion. In most cases we will be in touch should we require additional information.
While all personal information submitted to the HSUS will remain confidential, The HSUS cannot guarantee the confidentiality of personal information submitted to other agencies. For more information, please contact each agency directly about their policies.
6|Page Property of The Humane Society of the United States, June 2010, humanesociety.org/puppymills
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