WESTHOLME WAGYU SEMEN ORDER FORM

Please Print the form below, complete it fully then mail or fax it to:-

Maryanne Gibbons
PO Box 221
Dalby QLD 4405
Australia Fax: 07 4662 5201

Thank you for your order and interest in our sires.

Name:
Property or Stud Name:
Address:
State, Country:
Phone:
Fax:
Email:

J GROUP Sires		No. Straws		Unit Cost	Total
001 - Hirashige-Tayasu
002 - Itomoritaka
003 - Kitateruyasu-doi

A GROUP Sires		No. Straws		Unit Cost	Total
W0096 -Teruyamanami by 003
X0063 - Shigetanaka by 001
X0110 - Itoyoshiharu by 002
X0174 - Terutakanami by 003
X2046 - Kiyoyasu by 006

					[Aus +10%gst]
Order Total in A$
Deliver to:					Latest date required: Signature:
Payment Advice:	Cheque details: