College of Veterinary Medicine

Veterinary Cardiac Genetics Lab

Complete ONE copy of this PAYMENT form


Complete the following on your computer and then print using the Print Feature of your Web browser OR print first and complete the form by hand. PLEASE PRINT LEGIBLY. In addition, complete an individual cat form for EACH CAT (Go to Individual Cat Form)

Name
(person submitting samples)
Mailing Address
City State Zip    Country
Phone   FAX                                    E-mail
PLEASE program your email’s SPAM filter to accept emails AND emails-with-attachments from us! Our Email addresses:   vcgl@vetmed.wsu.edu    OR   MRoberts@vetmed.wsu.edu   Results will be Emailed as attached document unless no email is provided. If FAX is elected, please provide FAX Number

Pricing & Payment:

One test for each cat if samples for 1-4 cats submitted together: US $60 per test #cats x $60 = $
One test for each cat if samples for 5 or more cats submitted together: US $51 per test #cats x $51 = $
Both tests for each cat if samples for 1-4 cats submitted together: US $115 per cat #cats x $115 = $
Both tests for each cat if samples for 5 or more cats submitted together: US $102 per cat #cats x $102= $
TOTAL $

Make payment in US Dollars by check, money order, or credit card (MasterCard or Visa).  Do NOT send cash. Make checks payable to: VCGL-WSU 

If you are paying by credit card: Visa or MasterCard only.
Name on Card
Address of Cardholder
Card Number Expiration Date **VCODE
**The last three digits of lengthy number on the back of the credit card generally close to the signature line.

IMPORTANT: If you live in the UK or Europe, please call your bank to pre-approve this credit card transaction.
Test results will generally be available within two weeks. 

Send the labeled brushes or tubes of blood, this information sheet and payment to:   
 

Sent via US Postal Service

Veterinary Cardiac Genetic Laboratory (VCGL)
Washington State University
Post Office Box 605
Pullman, WA 99163-0605

 Sent via Federal Express or Other Carriers

Veterinary Cardiac Genetics Laboratory
Washington State University
Attn: Dr. Kathryn Meurs
100 Grimes Way
Pullman, WA 99164-7060

  Email VCGL@vetmed.wsu.edu

Phone: 509-335-6038


Last Edited: Apr 28, 2009 4:34 PM
Veterinary Cardiac Genetics Lab, PO Box 605 , Washington State University, Pullman WA 99163-0605, 509.335.6038, Contact Us   Safety Links