COOLED SEMEN ORDER FORM
* = REQUIRED INFORMATION

	TODAY'S DATE: 03/14/2010
	SELECT TYPE OF SERVICE: Cooled Semen Processing: $165.00 Cooled Semen Processing + Teaser Bitch: $200.00 Canine Cryobank Insemination Series: $150.00 Cooled Semen Inseminations Using Our Kits (2): $190.00 Progesterone Test: $50.00/each
STUD OWNER INFORMATION
* STUD OWNER FIRST NAME:
* STUD OWNER LAST NAME:
STUD OWNER ADDRESS 1:
STUD OWNER ADDRESS 2:
STUD OWNER CITY:
STUD OWNER STATE:
OWNER ZIP/POSTAL CODE:
* OWNER COUNTRY:
* OWNER TELEPHONE:
OWNER FAX:
OWNER EMAIL:
STUD INFORMATION
* REGISTRATION NUMBER:		(If not registered, enter "None")
* DOG'S FORMAL NAME:
* DOG'S CALL NAME:
* DOG BREED:
PURCHASER INFORMATION  (Name of Purchaser / Bitch Owner Receiving Cooled Semen)
* FIRST NAME:
* LAST NAME:
COMPANY NAME:
* ADDRESS 1:
ADDRESS 2:
* CITY:
* STATE/PROVINCE:
* ZIP/POSTAL CODE:
* COUNTRY:
* TELEPHONE:
FAX:
* EMAIL:
CANINE CRYOBANK IS SHIPPING TO:
* FIRST NAME:
* LAST NAME:
* HOSPITAL/FACILITY NAME:
* ADDRESS 1:
ADDRESS 2:
* CITY:
* STATE/PROVINCE:
* ZIP/POSTAL CODE:
* COUNTRY:
* TELEPHONE:
* FAX:
* EMAIL:
REQUESTED SHIPPING DATE (MM/DD/YYYY)
IMPORTANT SHIPPING INFORMATION
PLAN AHEAD! THERE IS AN ADDITIONAL $75.00 FEE FOR SAME-DAY ORDERS! All required information must be received by 11:00 a.m. Pacific time for Canine Cryobank to attempt same-day shipment. Canine Cryobank will make best efforts to make same-day shipments, but does not guarantee same-day shipment. Note that same-day shipment does not mean same-day delivery. If you require delivery quicker than FedEx can provide, you must contact us to make special arrangements for delivery and payment of the additional expenses. Also, please note that shipping charges are not included in the handling fees listed above, and will be billed directly to the FedEx number provided.
SHIPPING COST INFORMATION: FEDERAL EXPRESS PRIORITY  OVERNIGHT, 2-4 POUNDS. CALL 1-800-GoFedEx FOR COSTS. BE PREPARED TO GIVE THEM THE DESTINATION ZIP CODE AND 92069 FOR SHIPPING COST COMPUTATION.
* FedEx Account #:   Call 1-800-GoFedEx to get an account.	OTHER INFORMATION: