REQUEST FORM FOR CANINE DNA TESTING
(Can be used to submit multiple samples)
* * NOTE: You can fill in this form online to print and mail with your samples * *
| Owner: | Typical turnaround time: 7-10 business days | |
| Address: | COST = $40 for each test requested per dog |
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| Phone: | Preliminary Report by: Phone FAX Email | |
| FAX: | (Written report to be mailed within 4 weeks of results) | |
| Email: |
| Breed/Sex (N=Neutered Male; M=Intact Male; S=Spayed Female; F=Intact Female) |
ID (Registry #, Name) | Test(s) Requested E (includes 'e' & 'Em'); A (includes 'Ay', & Recessive Black 'a'); K=Dominant Black; B=(includes Brown alleles 'bc', 'bs', 'bd'); D=Dilute; S=Spotting) |
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| Please list any additional comments or specific questions for interpretation of the genetic testing results:
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| PAYMENT INCLUDED: $ | Check | Money Order | Paypal Sent |
| Visa | MasterCard | Card #: | Expiration: / |