Miner's Lamp‎ > ‎

Semen Request Form

2013
 
Downloadable PDF Version of this Form is available to print off at the bottom of this page.

I (name)……………………………………………………………………………….(please print)

have taken a Nomination to MINER’S LAMP at £ 900. (fee not subject to VAT)

for (mare’s name)………………………………………………………(please print)

THIS FORM MUST BE COMPLETED AND RECEIVED BY WEST KINGTON STUD ONE WEEK BEFORE THE SEMEN IS REQUIRED

(Please refer to Terms & Conditions for full delivery details)

DATE SEMEN REQUIRED BY………………DATE OF PLANNED INSEMINATION………………

 DETAILS OF DELIVERY ADDRESS

 

 DETAILS OF INSEMINATING VET

Name

 

Name of Vet

 

Address

 

Practice Name

 

 

 

Address

 

 

 

 

 

 

 

 

 

Post Code

 

 

 

Telephone

 

Post Code

 

Mobile

 

Telephone

 

Fax

 

Mobile

 

Email

 

Fax

 

 

 

Email

 

 CONFIRMATION OF  MARE’S DETAILS

 

 PEDIGREE

Registered Name

 

 

SIRE

GRANDSIRE

 

Stable Name

 

Breed

 

GRANDDAM

 

Colour

 

Height

 

DAM

GRANDSIRE

 

Age

 

Stud Book Reg. No

 

GRANDDAM


Upon receipt of the correct paperwork and payments, West Kington Stud will courier the frozen semen to your delivery address overleaf.  Together with the Semen Transport Flask you will find:

  • Semen Processor, thawing and handling instructions
  • Insemination protocol
  • Confirmation of receipt and insemination
  • Certificate of pregnancy diagnosis
  • TNT return documents/sticker
  • Return address label
  • Empty tank label
  • Instructions for returning the shipping container.

Please sign the below declaration and forward/fax (01249 782940) to:

       Tessa Clark, West Kington Stud, Church Farm, West Kington, Chippenham, Wiltshire. SN14 7JE

I have previously read and accepted the Miners Lamp Frozen Semen Terms and Conditions 2012/13.

£………. of the agreed Stud Fee of £………. was paid on………………….

I have enclosed the balance of the Stud Fee £……….(made payable to C.J. Hewlett) together with the Transport Flask Courier and Administration Fee of £120 made payable to West Kington Stud.

I am paying by cheque □   I am paying by Credit/Debit Card    (For card payments please complete details below)

Debit Card      Credit Card        Visa / Mastercard / Switch / Maestro (please delete as applicable)

Name that appears on card (please print)………………………………………………………………………………

Card Number…………/……………./……………/……………..   Start Date………………End Date………………

Issue Number (if applicable)………………………Security Code…………

I understand and agree to all details relating to Cancellation Fees and Stud Fee Refunds as set out in the Terms & Conditions

I understand that neither West Kington Stud nor C.J Hewlett can accept any responsibility for any damage to, or the condition of, the semen or container which occurs in transit.

Signed……………………………………………………………………………….…..Date……………………………

Print  Full Name in Capitals………………………………………………………………………………….…………..

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enquiries@haddontraining.co.uk,
13 Nov 2012 05:37