Fresh Chilled Semen Shipment Request Form

Doylestown Animal Medical Clinic Reproduction

802 North Easton Road

Doylestown PA, 18902

267-885-4808

repro@damcvets.com
Fresh Chilled Semen Shipment Request Form

PLEASE NOTIFY US 5 DAYS PRIOR TO YOUR REQUESTS SHIP DATE. This form is to be completed by the female's owner BEFORE the semen will be shipped.
DATE TO BE SHIPPED:*

MonthDayYear
Date
DATE TO BE RECIEVED BY:*

MonthDayYear
Date
OWNERS NAME (STUD):*
STUD'S REGISTERED NAME:*
Breed*
Call Name:*
AKC #*
OWNERS NAME (FEMALE):*
FEMALES'S REGISTERED NAME:*
Breed*
AKC #*
Call Name:*
SHIP TO: (WHERE)
HOSPITAL/CLINIC*
DR. NAME:*
ADDRESS:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
CITY:*
STATE:*
ZIP CODE:*
PHONE:*
Any shipping restrictions?*
SEND INVOICE TO:
NAME:*
ADDRESS:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
CITY:*
STATE:*
ZIP CODE:*
PHONE:*
Email Address*
example@example.com
*** All forms must be completed in full before the semen will be shipped. Shipping cost are usually paid by the female's owner. The stud owner is ultimately responsible for all charges if the Credit Card number used is declined. ***

Doylestown Animal Medical Clinic Reproduction

802 North Easton Road

Doylestown PA, 18902

267-885-4808

repro@damcvets.com
CHILLED SEMEN CREDIT CARD AUTHORIZATION FORM
The amount of $300.00 is for Chilled Semen Service which only includes
Collection, Preparation, and Packaging.
FedEx Shipping Fee is Not Included
The FedEx shipping fee is determined by the destination zip code.
Shipments are sent as Priority Overnight.
(We cannot accept third party FedEx account numbers as payment for shipping)
By signing below, I am authorizing Doylestown Animal Medical Clinic to charge my credit card for Chilled Semen Service and the FedEX Fees associated. Card will be charged prior to shipment leaving the building.
Signature of Cardholder

Clear

Doylestown Animal Medical Clinic Reproduction

802 North Easton Road

Doylestown PA, 18902

267-885-4808

repro@damcvets.com
Release of Liability
Chilled Semen
I, fully understand that Doylestown Animal Medical Clinic cannot be held responsible or liable for any delays in shipment due to time delays with FexEx, any customs or government office, any airline if shipping other than FedEx or the services of any hired brokerage service or agent. All semen delivery dates are estimates which have been provided to Doylestown Animal Medical Clinic by these agencies.
Occasionally there are weather/flight delays, paperwork, processing delays or the requirement of additional paperwork for customs clearance releases. I have been advised that extended time delays (past 5 days) or errors on the part of the customs agents may cause semen damage or destruction. I understand these are beyond the control of Doylestown Animal Medical Clinic and not the financial responsibility of Doylestown Animal Medical Clinic. Doylestown Animal Medical Clinic agrees to promptly provide any necessary paperwork to the shipping company (i.e.: FedEx) or a customs office in the event it is needed or required to expedite the clearance release and delivery.
In the event involving weather, flight delays, or poor semen motility
due to delays mentioned above
refunds will not be not be issued for services rendered and shipping fees.
I agree to hold Doylestown Animal Medical Clinic and employees of Doylestown Animal Medical Clinic harmless in the event that these delays occur or damage occur. I am releasing Doylestown Animal Medical Clinic of any liability due to these circumstances.
By my signature below, I am declaring I have read and agree with the above
Print Name:
Signature:

Clear
Date:

MonthDayYear
Date
Name*

First NameLast Name
Should be Empty:

Fresh Chilled Semen Shipment Request Form

SHIP TO: (WHERE)

SEND INVOICE TO:

CHILLED SEMEN CREDIT CARD AUTHORIZATION FORM

FedEx Shipping Fee is Not Included

Release of Liability

Chilled Semen