COOLED SEMEN ORDER FAX FORM - HAVERTY RANCH
FAX # (940)482-3833

Date _______________ Time ________________ Time Received: __________(OFFICE USE)

Name of Client ________________________ E-Mail _______________________

Day Phone Number: __________________ Night: ___________________ FAX: _________________

Address: _____________________________________________________________
_____________________________________________________________________

Shipping Address (for FED EX) ___________________________________________________________
___________________________________________________________

Please include any special shipping instructions and we recommend that you check with your local FED EX for specific delivery instructions. It is sometimes recommended that packages should be marked HOLD FOR PICK UP at the FED EX station, and we must have these instructions when we ship!

Payment:
_____ Check (prepaid) _____ Cash______ Money Order

Credit Card:
___ MasterCard # __________________ Expiration date: _________
___ VISA # ___________________ Expiration date: ____________

Name of cardholder: ________________________ Signature of Cardholder:___________________________

*Breeding fees and shipping fees must be prepaid or paid by credit card prior to shipment!
Credit Card #’s are required for deposit on Equitaners, but will not be run unless the container is not returned or is returned late. I authorize Haverty Ranch to use my credit card Listed above for the:

All semen must be ordered by 6pm (CST) the night before a regularly scheduled breeding day (Monday, Wednesday, Friday). Arrange for your vet to check your mare on Sunday, Tuesday, Thursday! Semen orders accepted the morning of breeding day (M, W, F) will be accepted upon availability and will be subject to a $25 additional late fee. Upon receipt of semen order, a FED EX tracking number will be FAXed back to you that evening to verify receipt of order. Mare owners are responsible for tracking any lost shipments.

Name of mare: _____________________
Servicing stallion: _____________________________
Palpation/ultrasound heat evaluation ______________________ Date ________________
Date semen needed ______________ (2 doses will be shipped - do not open package until mare is ready to breed!)

Closest Major Airport________________________________ (for same day service counter to counter ships only)
Preferred Airline_____________________________________

This form may be sent to us in advance to have on file.

Special Instructions___________________________________________________________