Ai-608 - Accredited Vet Supply Request Form

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AI-608 (8-15)
NYS Dept of Agriculture & Markets—Division of Animal Industry
10B Airline Dr. Albany, NY 12235 Ph: (518)457-3502 Fax: (518)485-0839
Category 2 Accredited Veterinarian’s Supply Request
PLEASE ALLOW AT LEAST 2 WEEKS FOR PROCESSING
Date: _______________________________
6 Digit NAN: ___________________________
Vet’s Name: ____________________________________________________________________________________________________
Name of Practice: _______________________________________________________________________________________________
Email Address: ______________________________________________________________ Phone: ____________________________
Mailing Address (we cannot ship to PO Boxes):________________________________________________________________________
City, State, Zip: _________________________________________________________________________________________________
CERTIFICATES OF VETERINARY INSPECTION
TUBERCULIN, PPD
_____
AI-4 Interstate CVI for Livestock, including Horses
NOTE: Tuberculin is shipped Mon-Thur
(Pad of 25)
NOTE: If you need a 1-time or continuing need for 100 dose
(10mL) vials, call this office about ordering information.
______ AI-61 Intrastate CVI for Exhibition (Pad of 50)
_______ 5 dose (1mL) Tuberculin PPD
VACCINATION CHARTS
_______ 40 dose (5mL) Tuberculin PPD
______ AI-17 Brucellosis Calf Vaccination Report (Pad of 25)
TEST CHARTS
______ AI-17A Brucellosis Calf Vaccination Continuation
(Pad of 25)
_______ VS Form 10-11 EIA Test Record (Pkg of 50)
______ AI-113 Livestock Rabies Vaccination Chart (Pad of 25)
_______ AI-11 TB Test Report for Cattle/Sheep/Goats/Swine
(Pad of 25)
_______ VS Form 6-22B TB Test Record Continuation Sheet
EAR TAGS
(Pkg of 50)
______ Regular 21 tags for cattle/bison/elk/red deer (Box of 100)
_______ AI-12 TB Test Report for Llamas/Alpacas (Pad of 25)
______ Brucellosis Vaccination tags (Box of 100)
_______ AI-12A TB Test Record Continuation for Llamas/
Alpacas (Pad of 25)
______
Allflex USDA-Approved plastic MED. bangle tags for
deer/pigs (bags of 50)
_______ AI-18 Brucellosis Test Record Form (Pad of 25)
______ Allflex USDA-Approved plastic LRG. bangle tags for cattle/
_______ AI-18A Brucellosis Test Record Continuation
elk (bag of 10)
(Pad of 25)
______ Eartag applicator for Allflex plastic tags
MISCELLANEOUS
Scrapie tags must be ordered from USDA (518) 858-1424
______ 2oz. Tattoo ink for Brucellosis Vaccination
______ Dept. Return Address Envelopes (indicate Lg or Sm)
Date Shipped: _____________ Initials: ______________
______ Other: ___________________________________

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