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Discount Application for Offspring of Normal to Normal Matings

Note: Correct pricing for NxN tests will not be automatically calculated in the online order. Please either pay by check or if paying by credit card, OptiGen will reduce the amount charged at the time the sample is received. Please note your bank may reserve funds immediately from debit cards when the order is placed.  For further information, please check out the NxN pricing chart.

Tier 1 tests - $75 each (does not apply to tests performed at other labs)

*** THESE DISCOUNTS DO NOT APPLY TO OFFSPRING OF CARRIER MATINGS ***
Client must send ALL of the following directly to OptiGen for reduced price testing:
  1. Completed copy of this form
  2. Optigen test reports for dam & sire documenting their Normal status*
  3. Provide copy of official document (e.g., registration) showing dam and sire as parents of this offspring
  4. Complete hand-written request form or complete online for additional 5% discount
  5. Blood sample or cheek swab (if the test allows use of swab)

*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:_________________________________________
 
Dog's Call Name: ___________________________ Registered Name: _______________________________
Registry:_____________________________________________________
 
Sireís Registered Name:__________________________________________
Sireís Registration Number:____________________
Sireís OptiGen Accession Number:______________
 
Damís Registration Name:_________________________________________
Damís Registration Number:____________________
Damís OptiGen Accession Number:______________
 
Office use only:
 
Verification of Sireís information:__________
Verification of Damís information:_________
Litter registration verification:____________
 
OptiGen Authorization Signature:_____________________________________ Date:___________
 

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OptiGen®, LLC · Cornell Business & Technology Park · 767 Warren Road, Suite 300 · Ithaca, New York 14850
Tel: 607 257 0301 · Fax: 607 257 0353 · email: genetest@optigen.com or optigen@clarityconnect.com
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