MIME-Version: 1.0 Content-Type: multipart/related; boundary="----=_NextPart_01C71308.286E6CA0" This document is a Single File Web Page, also known as a Web Archive file. If you are seeing this message, your browser or editor doesn't support Web Archive files. Please download a browser that supports Web Archive, such as Microsoft Internet Explorer. ------=_NextPart_01C71308.286E6CA0 Content-Location: file:///C:/A137A2E5/Optigenselfcomplete.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="us-ascii" Page Title

Optigen  <= /span>- Blood Sample / DNA Test Request Form

Please complete the form carefully and send to m= e at least one week in advance of the blood sample date. I use the data on = this form to enter your details on line then I print out a copy & send = back to you so that you & your vet can sign it. You should then pack th= at signed form with blood sample as per ‘Blood sample—collectio= n instructions’.

3D"Text<= ![endif]>

First name

Middle name

Address<= span style=3D'language:EN-GB'>

Postcode=

        = ;   Day

        = ;   Evening

Email=

3D"Text3D"Text<= !--[if gte vml 1]> True True 3 (``````````` (``````````` 20 True True True 1548000 684000

Please send results by -
= =

FAX

Telephone=

If you don̵= 7;t have Email do you want to use my Email & I will phone results to yo= u.

Yes  /  No
3D"Text<= !--[if gte vml 1]> True True 3 (``````````` (``````````` 27 True True True 4968000 720000

Optigen demand = payment by Credit card when test application is made on line. You save 5% b= y on line entry. Please fill in your card details quoting expiry date &= exact name on the card. Debit cards are not accepted. I promise to destroy= number as soon as I have entered it. Card is not charged until sample rece= ived by Optigen.

Card Number=

Name on card

Expiry date=

/
=
=

Email

 
=

Mail

 
=

Fax

 
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