FROZEN SEMEN ORDER FORM
* = REQUIRED INFORMATION
TODAY'S DATE: 10/15/2018
 

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: $125
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: