ICSB Mid Coast Mobile

Semen Release Form

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2021 Semen Release Form

 ICSB Mid Coast Mobile

504 Tamara Circle, Newark De 19711

 Fax: (302)533-5176 Email: midcoastmobile@gmail.com

This form must be completed by the semen owner, signed and submitted to ICSB Mid Coast Mobile 2 Business days before frozen semen can be released.   If it is not submitted with 2 business days, there will be additional charges:

1 Day notice $125.00

Same Day Notice $200.00

Processing over the Weekend $225.00

Processing over Holiday $250.00

There is NO Guarantee that ICSB MID COAST MOBILE can ship with less than 2 days notice 



Date of Request: ___________________ Date to Arrive:_______________ Number of Vials to Ship:_____________ 

________________________________________   ____________________________     ______________________

Registered Name Of Dog                                                                Breed                                       Registry & Number 

SHIP TO: Vet Name:_____________________________________________________Phone:_________________________

                  Facility Name:____________________________________________________________________________



  Bitch Owner: Name:___________________________________________Phone:___________________________

                Address: _____________________________________________________________________________­­­­________



              Registered Name Of Bitch____________________________________________________________________________

              Registry and Number:__________________________________________________________________________

 Credit Card Number______________________________________________EXP DATE_____________ Security Code_________

Billing Zip Code: _____________________ Name On Card__________________________________________________

I authorize ICSB Mid Coast Mobile to charge my credit card for tank & processing and Federal Ezpress expenses. I understand that if my credit card is declined the shipment will not be completed.

Signature of Card Holder:________________________________________________________________________

 Signature Of Semen Owner:___________________________________________________________________________

By signing and submitting this form. I understand that the ICSB Mid Coast Mobile Terms of Service apply to the collection, storage, shipment and use of this semen by me or another person.

  I also understand that while semen release expenses are usually paid by the bitch owner, the semen owner is ultimately responsible for all cost in the event that the bitch owner fails to pay all fees.


Print name of Semen Owner:____________________________________ Phone:_______________________


ICSB Mid Coast Mobile Charges:

$100.00  tank use and processing fee within the continental USA

$150.00 fee for outside the Continental USA.

additional charges will be added for any damages or tank used longer than 7 days

We use federal Express for shipping to and from facility

All prices are subject to change, ICSB terms of Service apply.

 Prices Effective June 1,2021



ICSB Mid Coast Mobile
504 Tamara Circle
Newark, De 10711
(302)294-6776 Office
(302)533-5176 Fax 
(302)379-9976 Katie Cell
(302)593-2684 Jennifer Cell for Collections

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