Submission form + Invoice to pet owner pe LABOR FÜR KLINISCHE DIAGNOSTIK GMBH & CO. KG Genetics Dog Customer-No. / Barcode PB 1810 DE-97668 Bad Kissingen Tel +49 971 72020 Fax +49 971 68546 Business Hours: Mo - Fr: 9:00 - 18:00 h, Sa: 9:00 - 13:00 h E-Mail:
[email protected] Clinic address: Owner: Invoice to: (Stamp or block letters) (Block letters only, please) Veterinarian Name: _________________________________________Owner First name:_________________________________________ Date of birth:__________________________________________________________________________________ (If the invoice should be sent to the owner or submitter, please (Owners signature for direct include their complete address and signature ) invoicing) Street: _________________________________________ VAT-No.: _________________________________________________ Please note: Zipcode/city: Address for invoicing and _________________________________________signee must be identical Fax / e-Mail: _________________________________________________ Tel.: _________________________________________ Date/Signature:_______________________________________________________________ Notification: Email Fax Mail Report copy to owner Courier 8105 Certificate 106,00 NOK (NOTE: Certificate is required by NKK, SKK, DKK etc., so please remember to request it, if applicable!) 1) The identity of the animal must be confirmed by a veterinarian (specified by Microchip-No. or Tattoo-No.) 2) Certificates are not issued for partner laboratory services 3) Certificates are included in the DNA-profile