SHIPMENT #:_________________________

SHIPPED SEMEN REQUEST FORM  (please use 1 form per shipment)
Fax To:  903-429-6898  or call Kim Dean at 903-429-6635 or 903-815-3347
Please write CLEARLY.
(You must receive voice confirmation from me that we are shipping semen if you placed order for semen via e-mail or via message on voicemail.)
Requests for semen must be made prior to 5pm CST the day prior to shipment or cancelled by 8am CST day of shipment.   All fees must be paid prior to shipment or pickup.

BREEDING FARM WILL NOT SHIP SEMEN WITHOUT ALL FEES BEING PAID IN ADVANCE

Date:_________________________________      Time:________________________


Mare Name:_________________________________________________________Breed_____________Reg#___________________________________

Owner Name:_______________________________________________________ Email:________________________________________________

Contact Person(if different from owner)____________________________________________________________________________________________

___________ FEDEX ($275)    

___________ FEDEX HOLD FOR PICKUP ($275)   

___________FED EX--SATURDAY ($305)   

___________FED EX (CANADA)  ($325)

___________FARM PICKUP ($125—using your container) 

___________SAME DAY SERVICE VIA AIR LINES within the US ($350)

Preferred Major Airport:

_____________________________________________________________________________________________

SHIP TO:

Business:____________________________________________________________________________________________________________

Name:__________________________________________________________________Email________________________________________

Physical Address:______________________________________________________________________________________________________

City_____________________________________________________________State________________________  Zip_____________________

Work#________________________  Home#__________________________  Cell#_______________________ Fax#:______________________

Credit Card Information: (card will be charged upon receipt of contract)

Please charge my credit card for all fees incurred in breeding my mare:

____Visa  ____MasterCard      Name of Cardholder:_______________________________________________________________________

Billing Statement Address:_____________________________________________________________________________________________

City____________________________________________________________State___________________ Zip _________________________

Card #___________________________________________________________     Exp Date __________     3 #’s on back of card __________

 
John and Kim Dean
P.O. Box 88 
Tioga, TX 76271 
Phone:  (903) 429-6635
Fax:  (903) 429-6898
(903)-815-1113 John's Mobile
(903)-815-3347 Kim's Mobile
Email: johnandkimdean@aol.com