Frozen Canine Semen Release Form - Icsb Georgia printable pdf download

FROZEN CANINE SEMEN RELEASE FORM – ICSB GEORGIA

This form must be completed by the semen owner and submitted to ICSB GEORGIA before frozen semen can be

released. Please submit this form to arrive at least 2 days before requested shipping date. If notice is less than two days, a

stat fee of $97.00 will be charged. While shipping costs are usually paid by the bitch owner, the semen owner is

ultimately responsible for all costs in the event that the bitch owner fails to reimburse ICSB GEORGIA for the shipping or

the return of the tank. Please complete and return this form to ICSB-GA, PO Box 547, Thomasville GA 31799.

Telephone (229) 226-1914 Email: or fax: 229-227-1757

____________________________________

________________________ _____________________

Registered Name of Dog

Breed

Registry and Number

NUMBER OF BREEDINGS TO RELEASE ONE TWO THREE OTHER______ (Circle one)

Ship to :

Name___________________________________ Phone #________________________

Veterinary Facility_________________________________________________________

Address_________________________________________________________________

City / State / Zip___________________________________________________________

For Use By:

Bitch Owner______________________________ Phone #________________________

Address_________________________________________________________________

City / State / Zip___________________________________________________________

Email address_____________________________________________________________

Registered name of bitch to be bred__________________________ Registration #__________________

The semen shipment should be shipped to arrive on or before____________________(date)

This shipment will be insured to cover the shipping tank replacement in the event of damage/loss during shipping.

Additional insurance to cover the value of the semen may be purchased, but a claim may not be honored by the

shipping company, since the semen is considered perishable goods. If desired, please indicate the amount you wish

to insure the shipment $________, realizing it is not likely to be honored in the event of loss.

Signature of semen owner______________________________________ Date_____________________

Printed name of semen owner_____________________________Phone#__________________________

Address______________________________________________________________________________

Street

City

State

Zip

ICSB-GA policy at this time is to provide use of the shipping tank for 7 days at a charge of $51.00. On the eighth day, a

daily rental will be charged of $14.00 until the shipping tank is returned, or until the replacement cost is reached.

October 2015

Frozen Canine Semen Release Form - Icsb Georgia