Brittmoore Animal Hospital
1236 Brittmoore Rd, Houston, TX 77043
713-468-8253 Fax:713-468-8995
Frozen Semen Shipment Information
All 3 forms (Shipment Information, Credit Card Authorization and Disposition) MUST be completed in full before the semen can be shipped. Shipping costs are usually paid by the bitch owner. If advanced notice of 2 FULL business days is given, then a shipment discount of $201.00 will be applied.
Today’s Date
Estimated Date of Breeding: Date Requested for Shipment:
Please check one of the following:
I have confirmed that my veterinarian has storage facilities for frozen semen. Ship at your convenience
My veterinarian does not store semen, but the bitch is in heat. Please ship on the date listed above.
This form is for future breeding arrangements. Please store semen until I notify you.
Stud Owner’s Name:Stud’s Registered Name:
Registry and Number #
Breed:
Call Name:
Bitch Owner’s Name:
Bitch’s Registered Name:
Registry and Number #
Breed:
Call Name:
SHIP TO:
Hospital Clinic:
Dr. Name:
Address:
City, State, & Zip Code :
Phone:
Send Receipt To:
Name:
Address:
City, State, & Zip Code:
Phone:
Frozen Semen Credit Card Authorization Form
I, the undersigned, do authorize Brittmoore Animal Hospital to charge my credit card for the shipment and processing of frozen semen shipment. (Visa, MasterCard and Discover only)
I understand that the charge of $397.65 is for semen preparation and initial tank rental. If initial notice, in writing (forms), of the shipment is given at least 2 full business days in advance, then a $201.00 discount will be applied to the total. I agree to pay $20.00 for every day the tank is not returned after the 4th business day. In addition, if the tank is not returned within 30 days or if it is returned damaged, I understand that my credit card will be charged a $1,000.00 replacement fee.
I also authorize Brittmoore Animal Hospital to put my credit card number on the Federal Express air-bill to pay the charges to ship the tank to its destination and back to Brittmoore Animal Hospital. There will be 2 FedEx charges and one charge from Brittmoore Animal Hospital.
By signing below I understand and agree to all of the conditions stated above.
Today’s Date :
Credit Card Number:
Name on Card:
Expiration Date:
Contact Phone Number:
Print Name:
Signature:
*** All 3 forms (Frozen Semen Shipment Information, Frozen Semen Credit Card Authorization, and Frozen Semen Disposition Form) must be completed in full before the semen can be shipped. Advanced notice of 2 full business days (Mon. – Fri.) is required for the discount of $201.00 to be applied. Shipping costs are usually paid by the bitch owner.