Welcome!

Please complete for your international health certificate.

Client Name

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

(###)

###

####

Patient Name

Barn Name

Sex

Age

Breed

Color

Markings

Please be descriptive (sock, blaze, star etc)

Hauler Name

First Name

Last Name

Hauler Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Hauler Phone

(###)

###

####

Hauler Email

If more than one hauler is being used, please state additional information below:

Name of Destination (Person or Organization)

First Name

Last Name

Destination Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Destination Phone

(###)

###

####

Haul Date

YYYY

Port(s) Traveling Through:

Reason for Traveling

Please state the reason for traveling i.e show, sale, trip etc.