All requests must arrive before 10 AM  the day before the semen is to be collected.  Please leave ALL the information on the answering machine if you reached the voice mail.  Speak slowly and clearly when leaving the message.    Please review the contract for more detailed terms and conditions.

Date called/faxed:_______________________

Mare Information:

Mare's name:
Size of follicle / Date Checked:
Date semen is needed at mare's location:

Veterinarian Information:

Name of Inseminating Veterinarian:
Phone number of inseminating vet:

Mare Owner Information:

Mare Owner Name:
Telephone # after 5:00 pm for confirmation:
Mare Owner FedEx Number (if available):
Mare Owner's Credit Card Number:
Card Type: (select one)	[  ] Visa  [  ] MasterCard
Credit Card Exp. Date:
Card Holder Name:
$225 per collection, charged by Velley Animal Hospital (408)847-3118 $35 per day container rental if container not returned within 4 days of shipment.	Card Holder Signature: _____________________________

Shipping Information:

Shipping address for semen delivery  (NO PO Boxes!)
Enter depot location if shipment must be held at a FedEx depot: