CELL HARVESTING AND CULTURE PROCESSING ORDER FORM
Fill out information, right mouse click on form, select "Print", then fax to 760.591.9939

TODAY'S DATE
  
KIT PURCHASER/OWNER INFORMATION
OWNER
 TELEPHONE FAX
ADDRESS
 E-MAIL ADDRESS
CITY/PROVINCE
 STATE ZIP COUNTRY
ANIMAL INFORMATION
ANIMAL IDENTIFICATION
Dog Cat Horse Llama Alpaca
Other
NAME

BREED
SHIPPING AND METHOD OF PAYMENT

EACH CELL HARVESTING KIT IS $1025
DATE SCHEDULED TO SHIP:

SHIPPING COST INFORMATION: FEDERAL EXPRESS OVERNIGHT, 2 POUNDS.
CALL 1 800 GoFedEx FOR COSTS.
BE PREPARED TO GIVE THEM YOUR ZIP CODE AND 92069 FOR SHIPPING COST COMPUTATION.

ACCT. #
For shipping tank out and back, call 1 800 GoFedEx to get an account number
USE OTHER SHIPPER/PAY ARRANGEMENTS
MONEY ORDER CHECK
VISA/MC #
EXP. DATE
FedEx A.W.B. #
 Use the FedEx AirWayBill # to track shipment
SEND CHECK OR MONEY ORDER TO: CANINE CRYOBANK, 120 N. PACIFIC A5, SAN MARCOS, CA 92069
DATE SENT