Domestic (US) Customers:
VMRD has a blanket USDA
APHIS import permit covering most domestic samples of the types
that we typicaly receive. Before shipping samples, please contact us to request a copy of this permit.
Be sure to specify whether you would rather receive the copy by e-mail, FAX or mail. Please
read the permit carefully to make certain that it covers the samples that you intend to submit. Please
remember to include a copy of the permit when you send the samples.
International (non-US) Customers:
We must obtain a USDA
APHIS import permit for your samples before you may send them.
Permits are generally valid for one year and can be renewed. There will be a $200 fee to offset our costs in
obtaining and purchasing the permit. We will also charge $100 for each renewal. Please contact us to arrange
a permit for your samples.
We apologize for any inconveniences arising from these permit requirements and thank you for your patience and understanding.
SENDER INFORMATION:
Date_______________ Clinic/Organization___________________________________________________________________________ Sender Name___________________________________________________________________________________ Veterinarian__________________________________________________________________________________ Address_______________________________________________________________________________________ City ________________________________________________________ State ______ Zip Code __________ Phone(_____)________________________________
TEST(S) REQUESTED:
_____CBC _____ImmunoPanel _____Coombs' _____ImmunoProfile _____CID Screeen _____Colostrum Profile _____Other:___________________________________________________________________________________ Special Instructions: ________________________________________________________________________
RESULTS TO:
Veterinarian yes no (circle one) Owner yes no (circle one) By phone (____)_____________________ By FAX (____)_____________________ By mail _____ By e-mail ______________________@_______________________________
SAMPLE ORIGIN:
Sample ID_____________________________________________________________________________________ Owner______________________________________________________ Phone(____)_______________________ Address___________________________________City________________________State______Zip__________ Animal Name__________________________________________________ Sex_____________________________ Species______________________________ Breed___________________________________________________ Age_______________________ Birth Date_______________________Sample Date_______________________ Dam________________________________________ Sire______________________________________________ Condition of Animal___________________________________________________________________________
BILLING INFORMATION:
Purchase Order Number______________________________________ Name_______________________________________________________ Phone(____)_______________________ Address________________________________City___________________________State______Zip__________
Please print a copy of and complete this form. Send completed form with samples to:
VMRD, Inc. Attn: Lab Services 4641 Pullman Albion Road Pullman, Washington 99163