Customer Account No: Order Form

...... Genetic Tests 125 Northenden Rd, Manchester M33 3HF Special price list for tests Submitted at Crufts 2012 tel 0161 282 3066 - fax 0161 973 3434 [email protected] - www.laboklin.co.uk

Veterinary Surgeon (stamp or block letters) Owner details (block letters) Only required if sample collected by a vet Full name: Address:

Town / City: County: Postcode: Country: Tel: Tel: Fax: Fax: Email: Email: Date: Signature: Date: Signature:

Reporting: [ ] Result to Vet [ ] Result to Owner - Please select ONE reporting method: [ ] Result by fax - [ ] Result by email - [ ] Result by post

Dog 1 Registered Name: ...... Call Name: ...... Breed: ...... Sex: [ ] Male [ ] Female. Date of Birth: ...... Microchip No ...... KC Registration ...... Coat Colour: ...... Sample: [ ] EDTA Blood [ ] Buccal swabs - Sample Date: ...... Sample label ...... Test (s) required (Provide both test number and test name from test list):

Dog 2 Registered Name: ...... Call Name: ...... Breed: ...... Sex: [ ] Male [ ] Female. Date of Birth: ...... Microchip No ...... KC Registration ...... Coat Colour: ...... Sample: [ ] EDTA Blood [ ] Buccal swabs - Sample Date: ...... Sample label ...... Test (s) required (Provide both test number and test name from test list):

Dog 3 Registered Name: ...... Call Name: ...... Breed: ...... Sex: [ ] Male [ ] Female. Date of Birth: ...... Microchip No ...... KC Registration ...... Coat Colour: ...... Sample: [ ] EDTA Blood [ ] Buccal swabs - Sample Date: ...... Sample label ...... Test (s) required (Provide both test number and test name from test list):

Dog 4 Registered Name: ...... Call Name: ...... Breed: ...... Sex: [ ] Male [ ] Female. Date of Birth: ...... Microchip No ...... KC Registration ...... Coat Colour: ...... Sample: [ ] EDTA Blood [ ] Buccal swabs - Sample Date: ...... Sample label ...... Test (s) required (Provide both test number and test name from test list):

* Declaration: I accept that, for UK registered , results of the tests in the attached list which are part of the Official UK Kennel Club DNA testing scheme will be sent to and published as part of the Kennel Club scheme.

Signed ...... (owner / agent) Date: ...... Payment: [ ] I enclose a cheque / Postal order payable to LABO KLIN (UK) for the amount of £ ...... [ ] I have already paid online by credit / debit card / paypal* the amount of £ ...... my payment reference number is: ...... * Paypal payment must be made to [email protected], please add 3% fees. EDTA blood tubes and cheek swabs are available free of charge, please email [email protected]. Any other information?:

This form is downloadable from www.laboklin.co.uk ISO / DIN 17025 Accredited Laboratory 125 Northenden Rd, Manchester M33 3HF Dog Genetic Tests tel 0161 282 3066 - fax 0161 973 3434

[email protected] - www.laboklin.co.uk

Crufts 2012 Price List  Test No Disease or Condition Name Cost Incl. VAT [ ] 8193D Arrhythmogenic Right Ventricular Cardiomyopathy (ARVC) * ( Boxer ) £ 64.80 [ ] 8219D Brachyury (Bobtail Gene / Short Tail) ( , Australian Stumpy tail cattle Dog , Austrian , Bourbonnais , Brazilian , Brittany £ 49.50 Spaniel , , Danish Farm Dog , Jack Russel Terrier , Karelian Bear Dog , , , Pyrenean Shepherd , Savoy Sheepdog , , Spanish Waterdog , Swedish Farm Dog , ) [ ] 8012 CLAD (Canine Leukocyte Adhesion Deficiency) ( Irish Setter ) Official UK Kennel Club DNA testing scheme in Irish Setter. Please sign the declaration. £ 49.50 [ ] 8011 CSNB (Congenital Stationary Night Blindness) ( ) Official UK Kennel Club DNA testing scheme in Briard. Please sign the declaration. £ 49.50 [ ] 8098 Canine Cyclic Neutropenia (Gray Syndrome) ( , Collie , , ) £ 49.50 [ ] 8000 Copper Toxicosis ( ) £ 49.50 [ ] 8013 Cystinuria ( Landseer , Newfoundland ) Official UK Kennel Club DNA testing scheme in Newfoundland. Please sign the declaration. £ 49.50 [ ] 8158D Degenerative Myelopathy / degenerative radiculomyelopathy) (All Dog Breeds, Boxer, Cardigan , , , Pembroke £ 67.50 Welsh Corgi, Poodle, Rhodesian Ridgeback, Wire ) Official UK Kennel Club DNA testing scheme in Chesapeake Bay Retriever. Please sign the declaration. [ ] 8194D Dilated Cardiomyopathy (DCM) * ( Doberman , Doberman Pinscher ) £ 64.80 [ ] 8142 Dwarfism (Pituitary Dwarfism / Hypopituitarism) * ( Czechoslovakian Wolfdog , German Shepherd , Saarloos Wolfdog ) £ 144.00 [ ] 8227D Episodic Falling / Falling Cavaliers (Cavalier ) £ 49.50 [ ] 8228D Dry Eye and Curly Coat Syndrome (Cavalier King Charles Spaniel) £49.50 [ ] 8229D Episodic Falling + Dry Eye and Curly Coat Syndrome (Cavalier King Charles Spaniel) £49.50 [ ] 8152 Exercise Induced Collapse ( EIC ) ( , Chesapeake Bay Retriever , Curly Coated Retriever , German Wirehaired Pointer , , £ 65.25 ) [ ] 8151 Factor VII Deficiency ( Airedale , , , Giant , ) £ 49.50 [ ] 8192D Familial Nephropathy (FN) / Hereditary Nephropathy ( ) £ 49.50 [ ] 8131D Familial Nephropathy (FN) / Hereditary Nephropathy * ( ) Official UK Kennel Club DNA testing scheme in English Cocker Spaniel. Please sign £ 65.25 the declaration. [ ] 8016 Fucosidosis ( English Springer Spaniel ) Official UK Kennel Club DNA testing scheme in English Springer Spaniel. Please sign the declaration. £ 58.50 [ ] 8066 GM1-Gangliosidosis ( Huskies ) £ 49.50 [ ] 8068 GRMD ( Muscular Dystrophy) ( Golden Retriever ) £ 49.50 [ ] 8007 Globoid Cell Leukodystrophy (Krabbe Disease) ( , West Highland White Terrier ) £ 49.50 [ ] 8156D Glycogen Storage Disease (GSDllla) ( Curly Coated Retriever ) £ 49.50 [ ] 8179D Neuropathy (Hereditary Neuropathy) ( Greyhound ) Official UK Kennel Club DNA testing scheme in Greyhound. Please sign the declaration. £ 60.30 [ ] 8222D Haemophilia A (factor VIII deficiency) ( Havanese Dogs ) £ 72.00 [ ] 8221D Haemophilia B (factor IX deficiency) ( Rhodesian Ridgeback ) £ 72.00 [ ] 8157 Hereditary Cataract ( Australian Shepherd ) Official UK Kennel Club DNA testing scheme in Australian Shepherd. Please sign the declaration. £ 49.50 [ ] 8073 Hereditary Myopathy / Centronuclear Myopathy (HMLR, CNM) ( Labrador Retriever ) Official UK Kennel Club DNA testing scheme in Labrador Retriever. Please sign £ 49.50 the declaration. [ ] 8192DS Hereditary Nephritis / Samoyed Hereditary Glomerulopathy ( Samoyed ) £ 49.50 [ ] 8154D Hyperuricosuria ( All Dog Breeds , American , , Bulldog , , French Bull Dog ) Official UK Kennel Club DNA testing scheme in £ 49.50 Black Russian Terrier , and Bulldog. Please sign the declaration. [ ] 8198D JEB (Junctional Epidermolysis bullosa) ( German Longhaired Pointer , German Pointers , German Shorthair Pointer , German Wirehaired Pointer ) £ 49.50 [ ] 8100DGD L-2-HGA (L- 2 - hydroxyglutaric aciduria) (Staffordshire ) Official UK Kennel Club DNA testing scheme in Staffordshire Bull Terrier. Please sign the declaration. £ 65.25 [ ] 8032 MDR1 Gene Defect / Sensitivity ( American , Australian Shepherd , Bobtail , Border collie , Collie , , German Shepherd, £ 65.25 Longhaired , McNab Shepherd (McNab Border Collie) , , Rough Collie , (Sheltie) , , Smooth Collie ) Official UK Kennel Club DNA testing scheme in Australian Shepherd , Shetland Sheepdog (Sheltie) , Rough Collie and Smooth Collie. Please sign the declaration. [ ] 8062 MH (Malignant Hyperthermia) ( All Dog Breeds ) £ 49.50 [ ] 8069 MPS ( Mucopolysaccharidosis type VII) ( German Shepherd ) £ 49.50 [ ] 8220D Myostatin Deficiency ("Bully" Whippet)/ Double Muscling ( Whippet ) £ 49.50 [ ] 8022 Myotonia Congenita ( ) £ 49.50 [ ] 8067 Narcolepsy ( Doberman , Labrador Retriever ) £ 49.50 [ ] 8155D Neonatal encephalopathy (NE) ( Standard Poodle ) £ 49.50 [ ] 8075 Neuronal Ceroid Lepofuscinosis ( NCL ) ( , Australian Shepherd , Border collie , Dachshund , , Miniature Long Haired Dachshund , £ 49.50 Miniature Smooth Haired Dachshund , Tibet Terrier) [ ] 8215D Osteogenesis Imperfecta ( Dachshund , Miniature Long Haired Dachshund , Miniature Smooth Haired Dachshund ) £ 49.50 [ ] 8104 PDP 1 Deficiency (Pyruvate Dehydrogenase Phosphatase 1 Deficiency) ( , ) Official UK Kennel Club DNA testing scheme in Clumber £ 49.50 Spaniel. Please sign the declaration. [ ] 8017 PFK Deficiency (Phosphofructokinase deficiency) ( , English Springer Spaniel ) Official UK Kennel Club DNA testing scheme in English £ 49.50 Springer Spaniel. Please sign the declaration. [ ] 8015 PK Deficiency (Pyruvate Kinase Deficiency) ( Basenji , West Highland White Terrier ) £ 49.50 [ ] 8002 PRA (Progressive Retinal Atrophy) ( Bull Mastif , ) £ 49.50 [ ] 8226D Primary Lens Luxation (PLL) ( Chinese Crested , German Hunt Terrier , Jack Russel Terrier , Jagd Terrier , Lancashire Healer , , Parson £ 49.50 Russel Terrier , , , , Tibet Terrier , , Volpino Italiano , W elsh Terrier , Wire-haired Fox Terrier , ) Official UK Kennel Club DNA testing scheme in Lancashire Healer , Miniature Bull Terrier , Sealyham Terrier , and Tibet Terrier. Please sign the declaration. [ ] 8191DD Startle Disease (SD) / Hyperekplexia ( Irish Wolfhound ) £ 72.00 [ ] 8143 Trapped Neutrophil Syndrome ( TNS ) * ( Border collie ) Official UK Kennel Club DNA testing scheme in Border collie. Please sign the declaration. £ 85.50 [ ] 8063 X-SCID (X-Linked Severe Combined Immunodeficiency) ( basset , Welsh Corgi ) £ 49.50 [ ] 8099DGC cord1- PRA ( Cone-rod dystrophy 1 ) ( English Springer Spaniel , Miniature Long Haired Dachshund , Miniature Smooth Haired Dachshund) Official UK Kennel Club £ 49.50 DNA testing scheme in Miniature Long Haired Dachshund, Miniature Smooth Haired Dachshund and Miniature Wirehaired Dachshund. Please sign the declaration. [ ] 8135 crd PRA (Cone-rod dystrophy form of PRA) ( Standard Wirehaired Dachshund, Miniature Wirehaired Dachshund ) £ 65.25 [ ] 8094 prcd - PRA ( Progressive Retinal Atrophy ) ( American Cocker Spaniel , American Eskimo , , Australian Shepherd , Australian Stumpy tail cattle £ 80.95 Dog , Chesapeake Bay Retriever , Chinese Crested , Dwarf poodle , English Cocker Spaniel , Entlebuch Mountain dog , , Gloden Retriever , , Labradoodle , Labrador Retriever , , Miniature Poodle , Norwegian Elkhound , Nova Scotia Duck tolling Retriever , Portugese Waterdog , Silky Terrier , , Swedish Lapp dog , Toy Poodle , Yorkshire Terrier ) [ ] 8002rcd1 rcd1 PRA (Progressive Retinal Atrophy) ( Irish Setter ) Official UK Kennel Club DNA testing scheme in Irish Setter. Please sign the declaration. £ 49.50 [ ] 8002rcd1a rcd1a PRA (Progressive Retinal Atrophy) ( Sloughi ) £ 49.50 [ ] 8002rcd3 rcd3 PRA (Progressive Retinal Atrophy) ( ) Official UK Kennel Club DNA testing scheme in Cardigan Welsh Corgi. Please sign the declaration. £ 49.50 [ ] 80143 von Willebrand disease Type III (vWD III) ( , Shetland Sheepdog (Sheltie) ) Official UK Kennel Club DNA testing scheme in Shetland Sheepdog (Sheltie). £ 79.20 Please sign the declaration. [ ] 80141 von Willebrand disease Type I (vWD I) ( Bernese Mountain Dog , Coton de Tulear , Doberman , Drentsche Patrijschond , , Kerry Blue Terrier , £ 79.20 , Miniature Poodle , Papillon , Pembroke Welsh Corgi , Poodle , Stabyhound , Standard Poodle , Toy Poodle ) Official UK Kennel Club DNA testing scheme in Doberman , and Standard Poodle. Please sign the declaration. [ ] 8210D von-Willebrand Disease ( Dutch Kooiker ) £ 72.00 [ ] 80142 von-Willebrand disease type II (vWD II) ( German Shorthair Pointer , German Wirehaired Pointer ) Official UK Kennel Club DNA testing scheme in German Wirehaired £ 65.25 Pointer. Please sign the declaration. Coat Colours / Length in Dogs  Test No Disease or Condition Name Cost Inc. VAT [ ] 9000DGD Coat (hair) Length (Border collie, Cardigan Welsh Corgi, Collie, Dachshund, German Shepherd, Pembroke Welsh Corgi, St. Bernard, Various dog breeds ) £ 49.95 [ ] 8023 Coat Colour: B-Locus (Brown Coat Colour) ( American Cocker Spaniel , Australian Shepherd , Bedlington Terrier , Border collie , Cardigan Welsh Corgi , £ 49.95 / £25.20 ± Dachshund , Dalmatian, Doberman Pinscher, English Cocker Spaniel, Flatcoated Retriever, Fox Terrier, French Bull Dog, Galgo Espanol , German Longhaired Pointer, German Shorthair Pointer, Labrador Retriever, , Newfoundland, Pointer, Portugese Waterdog, Scottish Terrier, Weimaraner ) [ ] 8144 Coat Colours: A-Locus Agouti ( fawn, sable, black and tan/tricolor, recessive black) ( All Dog Breeds ) £ 49.95 / £25.20 ± [ ] 8136 Coat Colours: D-Locus Dilution ( Doberman Pinscher , Labrador Retriever , Large Munsterlander , Miniature Pinscher , Newfoundland , Rhodesian £ 49.95 / £25.20 ± Ridgeback ) [ ] 8018 Coat Colours: E-Locus (yellow, lemon, red, cream and appricot) ( Afghan , Australian cattle dog , Australian Shepherd , Beagle , Border collie , Brittany £ 49.95 / £25.20 ± Spaniel , Cardigan Welsh Corgi , Chinese Shar-Pei , Chow Chow , Cocker Spaniel , Dachshund , Dalmatian , Doberman Pinscher , English Cocker Spaniel , English Setter , English Springer Spaniel , , Flatcoated Retriever , Foxhound , French Bull Dog , German Longhaired Pointer , German Shepherd , German Wirehaired Pointer , Labrador Retriever , Lowchen , Pointer , Pomeranian , Poodle , Pudelpointer ) [ ] 8146 Coat Colours: EM-Locus Melanistic Mask Allele (Em), E-Locus ( Afghan , Bull Mastif , Cairn Terrier , Cardigan Welsh Corgi , German Shepherd , Great £ 49.95 / £25.20 ± Dane , Greyhound , Saluki , Staffordshire Bull Terrier , Whippet ) [ ] 8145 Coat Colours: K- Locus ( All Dog Breeds ) £ 49.95 / £25.20 ± ± if your are testing the same dog for more than one coat colour, the cost of the first test is £55 and each additional coat colour test is £28.00 (£25.20 at Crufts) * partner lab This form is downloadable from www.laboklin.co.uk ISO / DIN 17025 Accredited Laboratory