REQUEST FORM FOR AVIAN DNA SEXING
* * NOTE: Please type or print legibly all information below * *
| Owner: | _______________________________ | CERTIFICATE REQUESTED: [ ] YES [ ] NO |
| Address: | _______________________________ | Preliminary Report by: [ ] Phone [ ] FAX [ ] Email |
| _______________________________ | (Written report to be mailed within 1 week of results) | |
| Phone: | _______________________________ | |
| FAX: | _______________________________ | # of Additional Sampling Kits Needed: |
| Email: | _______________________________ | (specify ______ Feather and/or ______ Blood) |
Submitted Samples
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Species |
ID (band #, name etc) |
For Lab Use Only |
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Payment Included: $____________ [ ] Check [ ] Visa [ ] MasterCard [ ] Coupon
Credit Card #________________________ Expiration: ___/___ Signature: ______________________
Pet DNA Services of AZ, PO Box 7809, Chandler, AZ 85246
Phone: 602-380-8552 Email: genes@petdnaservicesaz.comReferred by Beth at Pamperedpeeps Aviary
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