Coggins/ Export Intake Form
Please fill out this form prior to your appointment so we can prepare in advance.
Appointment is for:
*
Please Select
Coggins Only
Export Only
Coggins & Export
Owners Name:
*
First Name
Last Name
Owners Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
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Export
Purpose of Movement
Sale
Recreation / Holiday
Show or Performance
Other
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Export- Sale
Consignee or Buyers Name:
First Name
Last Name
Consignee or Buyers Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Consignee / Buyer Phone Number:
-
Area Code
Phone Number
Method of Travel
Air
Ground
Transport Company
Other
Departure Date
-
Month
-
Day
Year
Date
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Export- Travel
Travel Destination(s)
Departure Date
-
Month
-
Day
Year
Date
Return Date
-
Month
-
Day
Year
Date
Method of Travel
Air
Ground
Transport Company
Other
Other please describe
Airline or Transport Company Name
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Horse Information
Horse Barn Name:
Horse Registered Name:
Date of Birth:
-
Month
-
Day
Year
Date
known
estimated
Breed:
Color:
Coggins required for:
Show
Boarding
Training
Export
Submit
Should be Empty: