Sample Submission Form
page 1 of 4 ThoroughGen LLC • 758 Lisle Road • Owego NY, 13827-1164 Sample Submission Form thoroughgen.com Date of Submission: This form must be completed in full and returned with hair samples to ThoroughGen LLC Is this your first order with ThoroughGen? Yes No Results will be e-mailed in 5-10 business days, depending on the size of your order, and based upon receipt of payment in full AND this form completed in full with proper test samples. A YOUR INFORMATION [FILL IN ALL AREAS TO ENSURE PROPER DELIVERY OF YOUR TEST RESULTS] Personal Information Delivery Information (where your results will be sent) Title (Mr/Mrs/Ms/Dr): First Name: Last Name: Address: City: Zip: Country: E-mail: Phone: Fax: B Check here If same as Personal Info and proceed to B Title (Mr/Mrs/Ms/Dr): First Name: Last Name: Address: City: Zip: Country: E-mail: Phone: Fax: SAMPLE INFORMATION [FOLLOW DIRECTIONS CAREFULLY TO ENSURE PROPER TEST SAMPLE(S)] Total Number of Samples Enclosed: Directions for submission: • Samples • Pull 10-20 hairs from the horse’s mane or tail – be sure that the samples include the hair’s root • Place the samples into a plastic zip top baggie • Using a permanent pen or marker, complete one of the Sample Tags from page 3, cut it out and place it inside the plastic zip top baggie. This information must include the horse’s name or a unique ID# that you generate (keep this ID# for future reference). • PLEASE USE SEPARATE BAGGIES FOR EACH HORSE TO BE TESTED. DO NOT CROSS CONTAMINATE SAMPLES. WIPE/ WASH HANDS BETWEEN COLLECTING EACH SAMPLE. • Complete the Sample Order Summary (page 2) and check to be certain that all information matches what is provided on the individual Sample Tags C Under no circumstances will the source or the identity of the sample be revealed or shared with a third party (ThoroughGen Client) AUTHORIZATION Please sign to confirm that you have read and accept the terms and conditions listed on page 4. If owner or proxy is different from the ThoroughGen client, s/he must authorize the use of his/ her horse’s hair sample in a ThoroughGen genetic screen. By signing the owner does fully consent to donating their horse’s hair sample. Signature: Date: Printed Name: (Horse Owner/Proxy) Signature: Date: Printed Name: thoroughgen.com D page 2 of 4 PAYMENT Payment is required in order to initiate a genetic screen. If you have already completed your purchase online, please enclose a copy of your invoice with this Sample Submission Form. If you still need to arrange payment, please complete your purchase at www.thoroughgen.com or contact us at (607) 239-1366 and one of our Sales Associates will guide you through our simple ordering process. If you would prefer to pay by check, enclose your check made payable to ThoroughGen, LLC. Note that your results will be sent once your check clears and payment has been received in full. E SAMPLE ORDER SUMMARY [COMPLETE THE INFORMATION BELOW FOR EACH TEST ORDERED] Your Name: Date: Please complete all fields. If more than 8 samples are submitted, please print multiple copies of this page. Sample ID# Name of Horse Being Tested Year of Birth Sex M/F Dam Name Sire Name Testing Package(s) Select Testing Package: Racing Panel Breeding Cloud Select Testing Package: Racing Panel Breeding Cloud Select Testing Package: Racing Panel Breeding Cloud Select Testing Package: Racing Panel Breeding Cloud Select Testing Package: Racing Panel Breeding Cloud Select Testing Package: Racing Panel Breeding Cloud Select Testing Package: Racing Panel Breeding Cloud Select Testing Package: Racing Panel Breeding Cloud Office Use Only Date Received: Expedited Delivery? Initial & Date: Yes No Customer ID: Notes: Job #: thoroughgen.com F page 3 of 4 SAMPLE TAGS [COMPLETE ONE TAG FOR EACH SAMPLE AND CUT OUT ON DASHED LINES] Please print multiple copies of this page if more tags are needed Complete this tag, cut out and place into the corresponding plastic zip top baggie Sample ID#: Name of Horse (if applicable): Year of Birth: Dam Name: Sex M/F: Sire Name: Complete this tag, cut out and place into the corresponding plastic zip top baggie Sample ID#: Name of Horse (if applicable): Year of Birth: Dam Name: Sex M/F: Sire Name: Complete this tag, cut out and place into the corresponding plastic zip top baggie Sample ID#: Name of Horse (if applicable): Year of Birth: Dam Name: Sex M/F: Sire Name: Complete this tag, cut out and place into the corresponding plastic zip top baggie Sample ID#: Name of Horse (if applicable): Year of Birth: Dam Name: Sex M/F: Sire Name: Complete this tag, cut out and place into the corresponding plastic zip top baggie Sample ID#: Name of Horse (if applicable): Year of Birth: Dam Name: Sex M/F: Sire Name: Complete this tag, cut out and place into the corresponding plastic zip top baggie Sample ID#: Name of Horse (if applicable): Year of Birth: Dam Name: Sex M/F: Sire Name: Complete this tag, cut out and place into the corresponding plastic zip top baggie Sample ID#: Name of Horse (if applicable): Year of Birth: Dam Name: Sex M/F: Sire Name: Complete this tag, cut out and place into the corresponding plastic zip top baggie Sample ID#: Name of Horse (if applicable): Year of Birth: Dam Name: Sex M/F: Sire Name: G SHIPPING To complete your order, send pages 1 and 2 of this Sample Submission Form completed in full, along with all hair samples enclosed in zip top baggies with corresponding sample tags to: ThoroughGen LLC 758 Lisle Road Owego NY, 13827-1164 Please keep a copy of all submitted forms for your records thoroughgen.com page 4 of 4 TERMS OF SERVICE DEFINITIONS a. Approved Countries means the United States of America and Canada. b. “Delay” means longer than 24 hours for “expedited” shipping, and longer than 72 hours for “standard” shipping. c. Fees means standard price of the assay chosen, or agreed to by ThoroughGen and the client- see below. d. Order means your order for the Services which you submit to us by completing the Order Form and submitting a sample or samples. e. Order Form means the sample submission form which you must complete to make a valid Order as provided on the Website, sent to you by request or provided to you directly. f. Sample means the hair sample of one horse that you collect according to our defined Collection Protocol. g. Sample Result means the results of the tests conducted by us in relation to your Sample. h. Services means the scientific test(s) carried out by us to determine the genotype of your horse(s) and the provision that we will supply to the client a brief definition, including probability scores, for the genes that were tested on each horse. i. Website means www.thoroughgen.com. 1 ORDERING 1.1 Signing the above form is considered acknowledgement that you have read, understand, and agree to the following Terms & Conditions 1.2 Any potential conflicts will be resolved utilizing the following forms in order: (i) Terms (ii) Order Form (iii) Order Confirmation 1.3 By placing an Order with ThoroughGen LLC, you make a decision to accept the services of ThoroughGen LLC, 1.4 ThoroughGen LLC is free to accept or decline your request for service without need of explanation to the potential client. Possible reasons include, but are not limited to: (i) If we feel the samples were illegally obtained or that the client has no authority to request a genetic screen for horse in question (ii) In the case of a potential conflict of interest between you and another client of ThoroughGen 1.5 The Terms are binding once payment has been received. We will also issue an Order Confirmation to the client once payment has been received 1.6 Your Order Confirmation will include a Job Order Number. This number will be required for all follow-up correspondence with ThoroughGen 1.7 The Order Form can be obtained via phone, e-mail or by direct contact with a sales representative of ThoroughGen or by printing a copy of the form directly from the Website 1.8 Unless we are on site, the client has the sole responsibility to obtain the samples and deliver them to our laboratory, in accordance with these Terms and the Order Form 1.9 You will send samples to our facility at your own risk 1.10 ThoroughGen is not responsible for your sample until the moment that we receive the sample and assure that it is of sufficient quality for our testing measures. Once we establish the quality of the sample(s), we will send notification that the order is complete 2 WARRANTIES 2.1 We warrant that: (i) We are licensed to perform the duties as defined in this document (ii) We will provide the Services to you using all reasonable skill, care and diligence 2.2 You warrant that: (i) The Samples will be obtained by you, and you will deliver the Samples to us at your cost, in accordance with these Terms and the provisions on the Website and the Order Form, unless otherwise specified; (ii) you have the right and authority to take the Samples from the horse(s); (iii) all information provided by you to us for the purpose of ordering the Services is correct and that any credit card used to pay for the Service is owned by you (or that you have the owner’s authority to use it to pay for the Service) and that there is sufficient credit or funds to cover the cost of the Service. We reserve the right to obtain validation of such cards before accepting the Order; 2.3 You will indemnify, keep indemnified and hold us (and as applicable our officers, directors, employees, agents, licensors, subsidiaries, affiliates, suppliers and any of our third party service providers) harmless, on demand, against all claims, expenses, losses, damages, demands, costs (including all reasonable legal costs) and liabilities suffered by us as a result of you providing Samples which were not legally obtained arising from your breach of Clause 3 SERVICES 3.1 Upon receipt of the Order, and subject to the payment of the Fees by you, we will initiate the genetic screening of your samples in accordance with the Terms 3.2 We will make every reasonable effort to complete samples within time frame listed on the agreement, however, occasional problems occur with this type of advanced molecular biology assay (i) Orders purchased with expedited shipping will be given highest priority. In the event that a delay will result for any reason, a representative of ThoroughGen will contact the client to decide upon a course of action. Should the client determine that the results will not be provided in a time frame suitable to their needs, the client may choose to cancel the order and ThoroughGen will offer a refund (for expedited shipping orders only). ThoroughGen, however, will not be liable for any loss including any loss of business, profits, revenue and/or for any indirect or consequential loss as a result of any delay (whether or not due to our negligence) (ii) Orders purchased with standard shipping will be given the next highest priority. Again, in the event that a delay will result for any reason, a representative of ThoroughGen will contact the client to decide upon a course of action (iii) Results will be supplied in the times quoted in electronic form only (i.e. sent to an e-mail address or any other web address specified by the client). Should the client be unable to receive electronic mail, results will be supplied via priority mail and may require three additional days for delivery. Results for expedited orders that are unable to receive electronic mail will be sent via overnight delivery 3.3 The Sample Result provided to the client will include a certificate of authentication stating the results of the genetic profiling of your horse(s), as well as an e-mail or hard copy letter that includes a general explanation of the results obtained from the genetic profiling of your horse(s) 3.4 We have the right to retain all Samples received from you for at least seven (7) years following the date we issue the Sample Results to you. We also retain the right to destroy these Samples at any time and without notification to you 3.5 We reserve the right to terminate any Order you make following the Order Confirmation if you are in material breach of this Agreement including without limitation if payment has not been received in accordance with this Agreement 4 PAYMENT TERMS AND PRICE 4.1 Genetic screen tests will not be completed until the Services are paid in full 4.2 Payment can be made via credit card through PayPal 4.3 All Fees quoted are exclusive of all taxes, customer duties or similar tariffs and fees. You will be responsible for paying any such applicable taxes, duties and/or tariffs 4.4 We will determine if the Sample provided is adequate to complete testing. We may require you to submit a further Sample before we proceed to supply the Services. The collection of an additional sample may delay the completion of services 5 REFUND 5.1 Refunds will be ordered in the following circumstances: (i) In the case of an unusable Sample or of a Sample of insufficient quality (ii) In the event that we choose not accept your Order (iii) In the case of an unusable sample, if you choose not to provide an additional sample, ThoroughGen may charge the client for the work already completed; thereby providing only a partial refund 5.2 If you used a credit/debit card to pay the Fees we will reimburse the Fees paid by you directly to the credit/debit card you used when paying for the Services. Funds transferred directly from a bank account will be refunded directly to that account 6 LIABILITY 6.1 Our liability will not be limited or excluded for death or personal injury caused from our negligence or breach of duty or for fraud 6.2 Subject to Clause 6.1, we shall not be liable for: (i) Loss of revenue, wages, goodwill, business, profits, savings or data; and/or (ii) Any special, indirect, incidental, or consequential loss or damages; howsoever caused or howsoever arising, even if we have been advised of the possibility of such loss or damages or such loss or damages were reasonably foreseeable (iii) Subject to Clause 6.1 and without prejudice to the generality of Clause 6.2, you understand and agree that the Sample Results are provided for general information purposes only and that we provide no warranty, representation or other assurance and hereby exclude all liability howsoever arising from your use, interpretation, reliance or application of the Sample Results 6.3 Subject to Clause 6.1, our maximum liability in respect of all claims, losses or damages howsoever arising under or in connection with your Order and this Agreement shall be limited to the Fees paid by you 7 CONFIDENTIALITY 7.1 All information that you provide to us is considered strictly confidential unless otherwise agreed upon 7.2 All information that you provide to us will only be used in the provision of the Services or where otherwise agreed between us 8 MISCELLANEOUS 8.1 Under no circumstances in this Agreement are you considered an employee of or partner of ThoroughGen LLC 8.2 We reserve the right to enforce any or all of this agreement at any time. If any provision of this Agreement is determined by a court of competent jurisdiction to be invalid, illegal or unenforceable, all other terms of this Agreement will remain in full force and effect 8.3 The terms of this Agreement will be administered and interpreted in accordance with the laws of the United States (i) The included parties irreversibly submit to the exclusive jurisdiction of the U.S. courts
© Copyright 2024