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Discount Application for Offspring of Normal to Normal Matings
Client must send ALL of the following directly to OptiGen for reduced price testing:
*It is the Client's responsibility to obtain copies of the parents' test reports from the owner(s) of the parents. OptiGen cannot release test reports without written permission of the dog's owner. NOTES: This discount is not available in combination with any other discount. If result is anything other than Normal, client will be responsible for the difference in test pricing. Normal to Normal matings can only yield Normal offspring.
Client Name:___________________________________________________
Address:______________________________________________________
City:_______________________State:______________Country:__________
Zip/Postal Code:____________
Telephone:_____________________________________
Fax:__________________________________________
Email:_________________________________________
Litter birthdate:______________
Litter Registration Number:________________
Number of offspring to be tested:_______
Sire’s Registered Name:__________________________________________
Sire’s Registration Number:____________________
Sire’s OptiGen Accession Number:______________
Dam’s Registration Name:_________________________________________
Dam’s Registration Number:____________________
Dam’s OptiGen Accession Number:______________
Office use only: Verification of Sire’s information:__________
Verification of Dam’s information:_________
Litter registration verification:____________
OptiGen Authorization Signature:_____________________________________ Date:___________
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Page last updated January 11, 2008 Copyright 2005 OptiGen · Design and Programming by Spider Graphics Corporation® |
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