Release Frozen Semen | Pewee Valley Veterinary Center

Frozen Canine Semen Release Form: ICSB – Kentucky
This 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 release
breeding dose(s) of semen from the following dog:
Registered Name of Dog Call Name Breed AKC#
To the Following Person
Name of semen owner
Phone
Address
Street Address City State / Province / Region ZIP / Postal Code
Signature of semen owner*
Date
While 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 tank
This 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:
Name
Phone
Address
Street Address City State / Province / Region ZIP / Postal Code
Bitch Owner
Name
Phone
Address
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.Date
Name on Card
Billing Address on Card
Zip

Ship to: