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Frozen Semen Transfer Form

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 info@caninecryobank.com) before any shipment or transfer can occur.

Instructions

Semen owner information

  • Owner Name: As the semen owner, your name goes in the Owner Name box.
  • Owner Telephone: Type your telephone number so the Cryobank can contact you with any questions.

Stud information

  • 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

  • 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 here.
  • Country: If not the United States, type the name of the country here.
  • Telephone: Type the telephone number of the new owner or storage facility here.
  • FAX: If known, type the fax number here.
  • Email: If known, type the email address here.

Special Instructions: Type any additional information or instructions in the box.

TO BE COMPLETED BY SEMEN OWNER

Semen owner information
Stud information
New owner/storage facility

I authorize Canine Cryobank, Inc. to execute the above indicated actions.

Signature of Semen Owner: ______________________________________________

Date Signed: ______________________

Final steps

  1. STEP 1

    Print the form

  2. STEP 2

    Sign the form where indicated

  3. STEP 3

    Date the form where indicated

  4. STEP 4

    Fax the form to Canine Cryobank, Inc. at 760-591-9939 (or email a picture of the completed and signed form to info@caninecryobank.com)

Important

Canine Cryobank cannot ship or transfer any semen until we receive a completed transfer form. Please provide a telephone number where the Cryobank can reach you if there are any questions.

760-591-9909Fax: 760-591-9939info@caninecryobank.comBack to home