Fresh Frozen Plasma Order
 Fill out information, right mouse click on form, select "Print", then fax to 760.591.9939

TODAY'S DATE
  
PURCHASER/OWNER INFORMATION
OWNER
 TELEPHONE FAX
ADDRESS
 E-MAIL ADDRESS
CITY/PROVINCE
 STATE ZIP COUNTRY
SHIPPING AND METHOD OF PAYMENT

EACH 10 TO 12 CC TUBE $30.00. THIS MUST BE SHIPPED OVERNIGHT ON ICE PACKS
DATE SCHEDULED TO SHIP:

SHIPPING COST INFORMATION: FEDERAL EXPRESS OVERNIGHT 5 LBS. APPROXIMATELY $30.00
CALL 1.800 GoFedEx FOR COSTS.
BE PREPARED TO GIVEN THEM YOUR ZIP CODE AND 92069 FOR SHIPPING COST COMPUTATION.

ACCT. #
For shipping tank out and back, call 1 800 GoFedEx to get an account number
FedEx A.W.B. #
Use the FedEx AirWayBill # to track shipment
VISA/MC NUMBER
EXP. DATE
SEND CHECK OR MONEY ORDER TO: CANINE CRYOBANK, 120 N. PACIFIC A5, SAN MARCOS, CA 92069
DATE SENT