Address __________________________________________________________________________________

Home Phone ____________________ Work Phone ___________________ Fax ____________________

Cell Phone _____________________ E-mail _________________________ Other __________________

• STALLION'S NAME ____________________________________________

• MARE'S NAME ________________________________________________

• REGISTRATION # _________________________ OWNER ____________________________________

• SHIP TO _______________________________________________________(Contact Name & Business)

Address _______________________________________________________

Work Phone _________________ Fax __________________ After Hours Phone __________________

Cell Phone _____________________ E-mail ________________________________________________

• CLOSEST AIRPORT _________COUNTER TO COUNTER SERVICE IS NOT AVAILABLE AT THIS TIME___

• VETERINARIAN ______________________________________________________________________

Address ______________________________________________________________________________

Work Phone _________________ Fax __________________ After Hours Phone __________________

Cell Phone ___________________ E-mail _________________________________________________

• Check the following: Equitainer/EST provided by: ______Shipper     _____Mare Owner

Refundable Equitainer Deposit: Paid by Mare Owner _____

• Payment Type: ____ Check #  ___________    Amount:  __________________