FROZEN SEMEN PURCHASE FORM

STUD INFORMATION
DOG'S REG. #
TN78009108
TODAY'S DATE
DOG'S REG. NAME
CH Kate's Tribute to Denver
BREED AND COLOR
Pug

NEW SPERM OWNER INFORMATION
NAME
TELEPHONE CELL PHONE FAX*
ADDRESS
  E-MAIL
CITY/PROVINCE
STATE ZIP COUNTRY

FROZEN SEMEN PURCHASE
PAYMENT INFORMATION
COST $1000.00 PER SURGICAL INSEMINATION DOSE

 

VISA MASTERCARD EXP. DATE VCODE

If shipping is required,
please fill out the shipping address, preparation, and shipping fees
This form authorizes Canine Cryobank to ship frozen semen units for (Check One)
IMMEDIATE INSEMINATION
STORAGE TRANSFER

INSEMINATING VETERINARIAN OR STORAGE FACILITY
VETERINARIAN NAME
HOSPITAL NAME
ADDRESS
CITY
STATE
ZIP
COUNTRY
PHONE


PREPARATION FEES

PLAN AHEAD! Preparation fees for shipping frozen semen:
Same Day Shipping: $150 | Two-Day Shipping: $130 | Three or More Day $100

Credit Card needed for preparation fees:
VISA MASTERCARD
EXP. DATE VCODE


SHIPPING FEES

For shipping the shipping tank out Federal Express priority overnight and back, 2nd business day,
call 1800 GOFed Ex to get an account number.
Federal Express Account Number

To estimate shipping costs: Call Federal Express 1800GoFedEX or go to FEDEX.com. The tank weighs 28 pounds.
Be prepared to give them your zip code and 92069 for shipping cost computation.
Scheduled Shipping Date (It is best to ship on a Monday or Tuesday.)



IF YOU DO NOT GET A RESPONSE WITHIN 24 HOURS,
PLEASE CALL OUR LABORATORY: 760.591.9909