FROZEN SEMEN ORDER FORM
* = REQUIRED INFORMATION

	TODAY'S DATE: 04/23/2025
SEMEN OWNER INFORMATION
* OWNER FIRST NAME:
* OWNER LAST NAME:
* OWNER ADDRESS 1:
OWNER ADDRESS 2:
* OWNER CITY:
* OWNER STATE/PROVINCE:
* 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:
CHOOSE ONE
BITCH OWNER NEW SEMEN OWNER
* FIRST NAME:
* LAST NAME:
COMPANY NAME:
* ADDRESS 1:
ADDRESS 2:
* CITY:
* STATE/PROVINCE:
* ZIP/POSTAL CODE:
* COUNTRY:
* TELEPHONE:
FAX:
* EMAIL:
INSEMINATING VETERINARIAN OR STORAGE FACILITY INFORMATION
* 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)
SHIPPING AND METHOD OF PAYMENT
PLAN AHEAD! CANINE CRYOBANK HANDLING CHARGES: FOR SAME-DAY SHIPPING: $375 2-DAY SHIPPING: $250 3-DAYS OR MORE NOTICE: $200 Special Arrangements: TBD (minimum $375) 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 OVERNIGHT, 28 POUNDS. CALL 1-800-GoFedEx FOR COSTS. BE PREPARED TO GIVE THEM THE DESTINATION ZIP CODE AND 92069 FOR SHIPPING COST COMPUTATION.
* FedEx Account #: For shipping tank out and back, call 1-800-GoFedEx to get an account number	SPECIAL INSTRUCTIONS: