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.

Additional insurance will be the sole responsibility of the semen owner to cover the value of the semen.
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.

Doylestown Animal Medical Clinic Reproduction

802 North Easton Road

Doylestown PA, 18902

267-885-4808

repro@damcvets.com
Release of Liability
Chilled Semen
Shipping Delays

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.
Male Fails to Collect
There are times when a male may not successfully collect on the scheduled breeding day. We strongly encourage all owners to have a backup plan in place. This may include:

Identifying an alternate stud male
Being prepared to travel for a natural breeding
Adjusting timing if clinically appropriate
All parties (stud owner and female owner) should discuss this possibility in advance and agree on contingency options prior to the scheduled breeding date.

Semen Quality Upon Arrival
Despite proper collection techniques, advanced evaluation (including computerized motility analysis when applicable), and the use of high-quality extenders, semen may occasionally arrive with poor motility or be non-viable.

We recommend that stud and female owners discuss this possibility beforehand and establish a clear plan should semen quality be compromised.

Doylestown Animal Medical Clinic cannot be held responsible for the condition of semen once it leaves our facility. We do not have control over shipping conditions, temperature fluctuations, courier handling, or management once the sample is transferred to another facility or individual.
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