This form is filled out by the semen owner to instruct Canine Cryobank Inc. to ship and/or transfer ownership of semen stored at Canine Cryobank.
It must be signed and faxed (or a picture of the completed and signed form may be emailed to firstname.lastname@example.org ) to Canine Cryobank before any shipment or transfer can occur.
SEMEN OWNER INFORMATION SECTION
- OWNER NAME: As the semen owner, your name goes in the Owner Name box.
- OWNER TELEPHONE: Type your telephone number in the Owner Telephone box so the Cryobank can contact you with any questions.
STUD INFORMATION SECTION
- REGISTRATION NUMBER: Type the dog's registration number here. If not registered, type "None".
- FORMAL NAME: Type the dog's formal or registered name here. If no formal name, type "None".
- CALL NAME: Type the dog's informal or everyday name here.
- BREED: Type the dog breed here.
- NUMBER OF UNITS: Select the description that is most appropriate. If needed, you can provide more information in the Special Instructions area.
- COLLECTION DATE: Select the most appropriate description. If needed, you can provide more information in the Special Instructions area.
- CANINE CRYOBANK CLIENT #: The client number can be found on a yearly storage invoice. If it is not readily available, you can leave this item blank.
NEW OWNER/STORAGE FACILITY
Canine Cryobank needs to know to whom you are transferring semen ownership, or what facility will be the new storage location for your semen.
- NEW OWNER/FACILITY NAME: Type the name of the new semen owner or the new storage facility here.
- ADDRESS: Type the street address of the new owner or storage facility here.
- CITY, STATE, ZIP: Type the city, state, and ZIP or postal code of the new owner or new storage facility here.
- COUNTRY: If not the United States, type the name of the country of the new owner or new storage facility here.
- TELEPHONE: Type the telephone number of the new owner or storage facility here.
- FAX: If known, type the fax number for the new owner or storage facility here.
- EMAIL: If known, type the email address of the new owner or storage facility here
Type any additional information or instructions in the box.
- PRINT THE FORM
- SIGN THE FORM WHERE INDICATED
- DATE THE FORM WHERE INDICATED
- FAX THE FORM TO CANINE CRYOBANK, INC. at 760-591-9939 ( or email a picture of the completed and signed form to email@example.com )
CANINE CRYOBANK CANNOT SHIP OR TRANSFER ANY SEMEN UNTIL WE RECEIVE A COMPLETED TRANSFER FORM.
PLEASE ENSURE THAT YOU HAVE PROVIDED A TELEPHONE NUMBER WHERE THE CRYOBANK CAN REACH YOU IF THERE ARE ANY QUESTIONS.