Order Form: Stallion Compatability Analysis ($995)

First Name
Last Name
Farm Name

E-mail Address
Phone Number
FAX Number
		(Address information must match credit card entered below.)
Mailing Addr 1
Mailing Addr 2
Mailing Addr City
Mailing Addr State
Mailing Addr ZIP

		Enter overnight delivery shipping address - where you want your analysis to be delievered. Check here if same as Mailing Address above.
Shipping Addr 1 (No P.O. Boxes)
Shipping Addr 2
Shipping Addr City
Shipping Addr State
Shipping Addr ZIP

		You may only order a report for one broodmare at a time. If you have more than one broodmare you wish to analyze, please complete several copies of this form and submit each order separately.

Stallion Information
Name of Stallion
Sireline

Name of Stallion
Sireline

Name of Stallion
Sireline

Name of Stallion
Sireline

Name of Stallion
Sireline

Billing Information
Credit Card Type
Credit Card Number
Expiration Date (Mo/Yr)		/
Card Verification Code (3- or 4-digit security code) Show me where to find it
		Remember - Credit card account records must match mailing address entered above.

Anything else?		If you have any comments or anything further on your mind, please don't hesitate to tell us what else we need to know: