NEW ZEALAND SHEEP SAMPLE SUBMISSION FORM EFFECTIVE JUNE 01 2014

NEW ZEALAND
SHEEP SAMPLE
SUBMISSION FORM
EFFECTIVE JUNE 01 2014
Version: 1 Issue: 3
Authorised by: Technical Services
Billing Address
Company Name
Contact Person
Phone
Postcode
Fax
Physical Address
E-mail
Please indicate your preferred method of results delivery:
E-mail
Post
Fax
If you require a “Ram Certificate” please supply the following information:
Stud Name
Breeder Name
SIL MEMBERS
SIL Flock Code (one flock only per submission form):
I request the test results for these samples be added to my flock records on SIL
Name
(Please tick to request)
Signature
Breed
Animal Type (Sire, Ram, Ewe, Lamb)
Date Sampled
Sampler’s Name
Number of Samples
DNA Test Required
Shepherd®
Shepherd Plus
Shepherd 18
Inverdale®
WormSTAR®
I-Scan®
Other____________________
LoinMAX®
MyoMAX®
Notes: Note any irregularities. Continue on a
separate sheet if necessary
Urgent Samples: Samples processed urgently will incur an additional fee of $3 and results can be delivered
within 10 working days after the arrival of samples and payment at the Dunedin office.
Urgent
Submitters Declaration
To the best of my knowledge identification of samples in this envelope matches the tags of the animals sampled. Any exceptions are
included in the notes (above).
Samples contained in the envelope are submitted for immediate DNA analysis. I understand that by submitting these samples for testing
I am agreeing to the Zoetis Terms and Conditions available from: www.zoetis.co.nz/terms-conditions
Name: ______________________________________
I have enclosed payment details
Signature: ____________________________________
Date: ______________
Please ensure that all details on this form have been completed before submitting samples to Zoetis.
Post to: Zoetis, PO Box 5520, Dunedin 9058, New Zealand
Courier to: Zoetis, Level 4, 9 Moray Place, Dunedin 9016, New Zealand
Zoetis New Zealand Limited
PO Box 5520, Moray Place, Dunedin 9058, New Zealand
T 0800 228 278
T 03 477 5920
F 03 477 5930
E genetics.nz@zoetis.com
www.zoetis.co.nz/genetics
NEW ZEALAND
SHEEP PRODUCTS
PRICE LIST
EFFECTIVE JUNE 01 2014
Version: 1 Issue: 3
Volume
Price (per unit)
(Excl. GST)
10 – 99
$2.90
100 - 499
$1.80
500+
$1.50
DNA Tissue Test Kits (TSU)
1+
$2.90
DNA Banking
1+
$3.00
Extraction (Fee for testing Semen or Whole Blood
1+
$21.00
Sheep 50K
1+
$400.00
Sheep 5K
1+
$69.00
1 – 99
$35.00
100+
$26.00
Shepherd® Profile – Sires
1+
$50.00
Gene Test Report from Shepherd® Profile
(MyoMAX®, LoinMAX®, WormStar™)
1+
$5.00
Shepherd 18
1+
$40.00
1 - 189
$65.00
190+
$20.00
Shepherd® Plus Profile - Sires *NOTE 1
1+
$50.00
Gene Test Report from Shepherd® Plus Profile
(MyoMAX®, LoinMAX®, Inverdale)
1+
$5.00
1 - 25
$80.00
26 - 50
$70.00
51+
$55.00
MyoMAX® and I-Scan®
1+
$39.00
Inverdale
1+
$50.00
Urgent Fee if applicable
1+
$3.00
Products Available
DNA Blood Spot Test Kits (FTA)
samples. N/A for Sheep 50K)
Shepherd® Profile – Dams and Lambs
Shepherd® Plus Profile – Dams and Lambs *NOTE 1
MyoMAX®, LoinMAX®,
I-Scan® and WormStar™
PLEASE NOTE: All prices exclude GST. Results can be expected three weeks after payment has
been made and the samples arrive at the laboratory, however processing of Shepherd Plus,
Sheep 50K and Sheep 5K is determined by volume and can fall outside of the three week time frame.
*NOTE 1 : Samples numbering less than 10 may have delays. Please contact the Zoetis team if testing is urgent.
Zoetis New Zealand Limited
PO Box 5520, Moray Place, Dunedin 9058, New Zealand
T 0800 228 278
T 03 477 5920
F 03 477 5930
E genetics.nz@zoetis.com
www.zoetis.co.nz/genetics
Authorised by: Technical Services
#
Required
Sub-total
+GST@15%
Total
Total Price
(Excl. GST)
MAKING
PAYMENT
TO ZOETIS
EFFECTIVE APRIL 04 2013
Version: 1 Issue: 1
Authorised by: Technical Services
Credit Card Payments
Please complete the credit card details below.
Alternatively you can phone 03 477 5920 to make a credit card payment over the phone.
cheque Payments
Please make cheques payable to Zoetis NZ Ltd. Please post cheques with your test request form to:
Zoetis – Genetics
PO Box 5520
Dunedin 9058
direct deposits
When making a direct deposit please quote your reference details in the direct deposit section below.
Please use your trading name as the reference if possible.
Bank:
Westpac Banking Corporation
Account Name: Zoetis New Zealand Ltd
Account No:
03 0252 0847064 00
Payment options
Account
Number:
Cheque
Direct Deposit
Reference Details:
Charge Credit Card
Card Type:
VisaMastercard
Cardholder’s full name as it appears on the card: _____________________________________________________
Credit Card Number: _____________________________________________Security Code: _______________
(3 digit code on reverse of card by signature panel)
Expiry Date: ______/______
Cardholder’s Signature: _____________________________________________Date: _______________________
*By signing this agreement you authorise Zoetis NZ Ltd to debit your credit card the full amount due at the time of order
acceptance.
If you do not have an account with Zoetis your order must be paid for up front.
A tax invoice will be issued following delivery of test results. Terms and conditions are available at:
www.zoetis.co.nz/terms-conditions which together with this order document constitutes the sale contract.
Please tick this box to have a copy of the terms and conditions posted.
Zoetis New Zealand Limited
PO Box 5520, Moray Place, Dunedin 9058, New Zealand
T 0800 228 278
T 03 477 5920
F 03 477 5930
E genetics.nz@zoetis.com
www.zoetis.co.nz/genetics