DNA Sexing - Australia

SAMPLE FORM - NEW ZEALAND

TO TAKE THIS TEST NOW FOLLOW THESE STEPS:
1. Please print this page out. Otherwise contact us and we'll send this form to you.
2. Please record identification or name details for each sample collected, and to be tested.
For example (Ring #13 Black, Tweety, Red Parrot, cage 10, etc.)
3. Pull 2 feathers from each bird to be tested.
4. Results will take 6 to 12 days.
5. This form available in high resolution format (with instructions), by clicking here.

Please send samples to:

By Airmail	DNA SOLUTIONS 4 Eastgate Court WANTIRNA VIC 3152 AUSTRALIA
Tel:	0800 362 8378 (Free call from NZ)
Email	dna@dnasolutions.com.au

Please complete following contact details:

Name:

Phone:

Address:

Email:

Fax:

	Bird ID:	Species:	Official Use
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I am paying (tick box)

	NZ$19 each (for sending us 1 - 9 bird FEATHER samples)
	NZ$18 each (for sending us 10 or more bird FEATHER samples)
	NZ$21 each (for sending us 1 - 9 bird BLOOD samples)
	NZ$18 each (for sending us 10 or more bird BLOOD samples)

Please select one or more of the following methods to receive your results:

	email		By regular mail
	By fax		By telephone

Please select method of payment:

	Mastercard	Visa Card	Bankcard
	*Cheque	*Money Order	Bank Wire
If paying by cheque or money order, please make payable to "DNA SOLUTIONS*"

Credit Card details

Card number:
Cardholder's full name:
Expiry date:

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