First Name |
|
|
Last Name |
|
|
Farm Name |
|
|
|
|
|
E-mail Address |
|
|
Phone Number |
|
|
FAX Number |
|
|
|
|
(Address information must match credit card entered below.) |
Mailing Address 1
|
|
|
Mailing Address 2 |
|
|
Mailing Address City |
|
|
Mailing Address State |
|
|
Mailing Address ZIP |
|
|
|
|
|
|
|
Enter expedited delivery shipping address -
where you want your analysis to be delievered.
Check here if same as Mailing Address above. |
Shipping Address 1
(No P.O. Boxes) |
|
|
Shipping Address 2 |
|
|
Shipping Address City |
|
|
Shipping Address State |
|
|
Shipping Address ZIP |
|
|
|
|
|
|
|
You may only order a report for one stallion at a time. If you have more than one stallion you wish to analyze, please complete several copies of this form and submit each order separately. |
Stallion Information |
|
|
|
|
|
Sireline |
|
|
|
|
|
Name of Stallion |
|
|
Sireline |
|
|
|
|
|
Name of Stallion |
|
|
Sireline |
|
|
|
|
|
Name of Stallion |
|
|
Sireline |
|
|
|
|
|
Name of Stallion |
|
|
Sireline |
|
|
|
|
|
Billing Information |
|
|
Credit Card Type |
|
|
Credit Card Number |
|
|
Expiration Date (Mo/Yr) |
|
/
|
|
|
|
|
|
Remember - Credit card account records must match mailing address entered above. |
|
|
|
Anything else? |
|
If you have any comments or anything further on your mind, please don't hesitate to tell us what else we need to know:
|
|
|
|
|
|
|
