Release Frozen Semen Frozen Canine Semen Release Form: ICSB – KentuckyThis form must be completed by the semen owner and submitted to ICSB-Kentucky before frozen semen can be released. Please submit this form to ICSB – Kentucky at least three (3) days before requested shipping date. I hereby authorize International Canine Semen Bank – Kentucky to releasebreeding dose(s) of semen from the following dog:Registered Name of DogCall NameBreedAKC# To the Following PersonName of semen ownerPhoneAddress Street Address City State / Province / Region ZIP / Postal Code Signature of semen owner*DateWhile shipping costs are usually paid by the bitch owner, the semen owner is ultimately responsible for all costs in the event that the bitch owner fails to reimburse ICSB-KY for the shipping or the return of the tankThis shipment will be insured by ICSB-KY to cover the shipping tank replacement in the event of damage/loss during shipping. Additional insurance to cover the value of the semen may be purchased. If desired please indicate the amount you wish to insure the shipment $Ship to:NamePhoneAddress Street Address City State / Province / Region ZIP / Postal Code Bitch OwnerNamePhoneAddress Street Address City State / Province / Region ZIP / Postal Code The semen shipment should be shipped to arrive on or before:Charges are to be billed to (Visa, MasterCard, or Discover) #Exp.DateName on CardBilling Address on CardZip
