2026 - Client Intake Form

2026 - Client Intake Form
ESTIMATE or FILE #:
Full Name:*

First NameLast Name
Tel #:*
Alternate Tel #:
Email:*

Confirmation Emailexample@example.com
Preferred Shipping Date:*

DayMonthYear
If you have a preferred Airline and/or Flight #, please enter details here:
UK or EU Destinations Only: Will you or someone be flying within 5 days of pet(s)
Origin Contact Name:

First NameLast Name
ORIGIN Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Do you require Pick-up from Residence?:
Pick-up Contact Name:

First NameLast Name
Pick-up Contact Tel #:
Please enter a valid phone number.
Pick-up Contact Email :
example@example.com
Pick-up Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Destination Name:

First NameLast Name
Destination Tel #:
Please enter a valid phone number.
Destination Email :
example@example.com
DESTINATION Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Please add the following Services/Items:

Vet Services (Meet & Greet at Vet Clinic)Vet Services (Pick-up required)Government Endorsement of Documents (International Shipments only)Boarding prior to DepartureImport Permit Application and FeesPEQ (Quarantine) Booking and Fees
Boarding From:

DayMonthYear
Boarding To:

DayMonthYear
Destination Service Options - Do you Require Destination Customs Clearance and/or Delivery to Residence?:

NO - I will Clear Customs (where applicable) and Pick-up at Destination AirportNO - I will be using (and paying) the following Agent for Clearance and/or DeliveryYES - Please recommend an Agent for Clearance OnlyYES - Please recommend an Agent for Clearance and DeliveryCheck this box if you wish Destination Services to be added to emBARK Final Invoice
Note: Mark-up for Banking and Exchange fees to 3rd party overseas agent will be between 10% - 20% depending on currency conversion
Agent Details:

Name of Company and Representative

Address

CityState / Province

Postal / Zip CodeCountry
Agent Email:
example@example.com
Agent Tel #:
Please enter a valid phone number.

Pet Details:

	Name	Microchip #	Species	Breed(s)	Colour	Sex
Pet 1
Pet 2
Pet 3
Pet 4
Pet 5

Pet Details (continued):

	Weight	LB / KG	Length	Spynx Pose (lay down length)	Width	Height	CM / IN
Pet 1
Pet 2
Pet 3
Pet 4
Pet 5

Pet Details (Important Dates) - enter as DD/MM/YYYY:

	Date of Birth	Microchip Implant Date	Most Recent Rabies Date (Given)	Prior Rabies (if most recent is greater than 1 year)	Titre Test Date (if applicable)
Pet 1
Pet 2
Pet 3
Pet 4
Pet 5

Crate Details:*

	Do you Require a Crate?	If No - Provide Measurements (LxWxH)	CM / IN	Check if crate is wooden	Apx Weight of Crate	lb / kg
Pet 1
Pet 2
Pet 3
Pet 4
Pet 5

I confirm that the above information to be accurate. I understand that services or items added will reflect the final invoice.

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