Freezing Authorization Form

Subzero Canine Reproduction (SCR) agrees to collect, freeze and store canine semen from the above dog. The frozen semen will be available to the semen owner(s) for use/shipping following standard procedures, instructions to be supplied to the semen owner after the semen is stored. Payment is due at the time of collection, unless a monthly payment plan is requested/approved. Initial collection, freezing and storage fees will include the first year of semen storage.

Late payment is subject to a 1% per month (12% APR) interest and $5.00 late fee per month. After 90 days of non-payment, the account will be placed in inactive status. A charge for reactivation will be made. After 180 days (6 months) of non-payment, the frozen semen will be subject to disposal and/or ownership will be given to SCR for use as SCR sees fit. This may include sale or transfer of ownership of the frozen semen by SCR. The account balance will be submitted to a collection agency for collection. Accounts must be current for frozen semen to be released. It is my responsibility to ensure my account remains current with SCR. Any change of address or phone number needs to be provided to SCR immediately.

Subzero Canine Reproduction (SCR) policy is to email invoices and statements.

Subzero Canine Reproduction (SCR) fees for semen collection, freezing and storage are charged at the time of collection and on an annual basis for storage. There are additional fees charged by SCR when the stored semen is shipped for breeding or transfer. These fees are usually termed shipping preparation, shipping tank rental, and actual shipping charges to ship the semen to its destination and for the return of our empty tank.

Sperm cells will eventually cease living, but no one knows or can predict when this will occur, and it can vary from dog to dog. SCR shall not be held liable for, and cannot guarantee conception from, frozen canine semen. Nor can SCR guarantee that the frozen sperm cells will be viable at the time of thawing for insemination.

In the event of loss or damage of frozen semen due to natural causes due to weather, fire, storage/shipping tank failure, or shipping tank accident/damage, SCR would not be held liable for the loss or the replacement value of the frozen semen.

NOTE: If this dog is owned by more than one owner and the person completing this authorization form wishes to be the sole owner of this frozen semen, a TRANSFER OF OWNERSHIP form must be completed and returned to SCR by each owner/co- owner, agreeing to transfer the ownership of this frozen semen to the owner/co-owner wishing to be sole owner of this semen.) If an agent is presenting the dog for collection, and expects to own the semen, a TRANSFER OF OWNERSHIP form must be completed and returned to us as well. This semen is the property of the person/persons who own this dog on the date of semen collection.

SCR is required to have a copy of the dog's registration before the frozen semen can be released for use.

By my signature below, I authorize Subzero Canine Reproduction (SCR), to perform services for me. I agree to all statements made in the document preceding this signature and any statements made in the following document. I understand SCR does not guarantee fertility or successful fertilization. I also understand SCR is not responsible for services rendered by professionals of any other company. My payment for SCR services is due at the time of the service. Other charges may be applied to my credit card at a later date, if additional services are necessary. SCR may or may not notify me of these additional charges prior to charging my credit card. Any charges may be made without my permission. In the event I initiate a chargeback, I understand I will be charged additional office fees. If SCR must prove in any way that I authorized the use of my credit card, I will incur additional fees for personnel time required to prepare a response to my chargeback. I also agree that any person I allow to access my frozen semen at SCR, or any person that pays fees billed to my account at SCR will be guaranteed by me. Any person I ask SCR to bill on my behalf will be informed by myself of fees or charges made by SCR to their credit card. If the person reverses any charge at SCR, I will be held liable for reimbursement to SCR immediately. It is my responsibility to ensure SCR is paid for all services performed by or charged through Subzero Canine Reproduction, (SCR) to my account.