Form AQS-73 "Request for Electronic Microchip" - Hawaii

What Is Form AQS-73?

This is a legal form that was released by the Hawaii Department of Agriculture - a government authority operating within Hawaii. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on July 1, 2003;
  • The latest edition provided by the Hawaii Department of Agriculture;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a printable version of Form AQS-73 by clicking the link below or browse more documents and templates provided by the Hawaii Department of Agriculture.

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Download Form AQS-73 "Request for Electronic Microchip" - Hawaii

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AQS-73
07/03
REQUEST FOR ELECTRONIC MICROCHIP
All dogs and cats attempting to qualify for the 30-day or 5-day or less quarantine programs are required to have an
implanted electronic microchip. Effective June 30, 2003, the State of Hawaii will only provide microchips for request
outside of the 50 States of the United States. Microchips must be readable with an AVID scanner (AVID chip, Home
Again chip).
For 30-day or 5-day or less quarantine, the microchip MUST be obtained before the OIE-Fluorescent Antibody
u
Serum Neutralization Test (OIE-FAVN test). The OIE-FAVN test must be completed between 90 days and 18 month
prior to arrival in Hawaii.
Please allow one-to-two weeks for processing and delivery of microchip.
Mail completed form and payment to:
Department of Agriculture
or fax to (808) 483-7110
Animal Quarantine - Microchip Request
(credit card payments only)
99-951 Halawa Valley Street
NO REFUNDS
Aiea, HI
96701-5602
ALL SALES FINAL
COST: Microchip to Foreign Country Address
$27.00 each (U.S. currency)
_________________________________________________________________________________________________________________________________________________________________
Please print
OWNER: ________________________________________________________ Telephone: (_______) ______________
(Last name)
(First)
(MI)
NUMBER OF MICROCHIPS REQUESTED: _____________ X $ ______________ = $ ________________
Cost per microchip
Total Cost
Payment in advance required (Check one):
o
Money order, cashiers' check, or bank draft (Payable to Department of Agriculture). No Personal Checks.
o
Credit Card (complete the following information)
o VISA
o Mastercard
Name on Credit Card: __________________________________
Credit Card Number: ___________________________________
Expiration Date: _____________________
Signature: ___________________________________
PET INFORMATION (Complete for each microchip requested)
Pet's Name
Dog Cat
Breed
Sex
Age
Color
Markings
oo
1._________________
1. _________________________________________________________
oo
2._________________
2. _________________________________________________________
oo
3._________________
3. _________________________________________________________
oo
4._________________
4. _________________________________________________________
oo
5._________________
5. _________________________________________________________
oo
6._________________
6. _________________________________________________________
MAILING LABEL
(Print or Type)
TO:
_________________________________________________
Please fill out carefully.
The microchip will be mailed
_________________________________________________
to the address on the
mailing label.
_________________________________________________
The State is not responsible for
_________________________________________________
microchips lost or damaged
during shipment.
AQS-73
07/03
REQUEST FOR ELECTRONIC MICROCHIP
All dogs and cats attempting to qualify for the 30-day or 5-day or less quarantine programs are required to have an
implanted electronic microchip. Effective June 30, 2003, the State of Hawaii will only provide microchips for request
outside of the 50 States of the United States. Microchips must be readable with an AVID scanner (AVID chip, Home
Again chip).
For 30-day or 5-day or less quarantine, the microchip MUST be obtained before the OIE-Fluorescent Antibody
u
Serum Neutralization Test (OIE-FAVN test). The OIE-FAVN test must be completed between 90 days and 18 month
prior to arrival in Hawaii.
Please allow one-to-two weeks for processing and delivery of microchip.
Mail completed form and payment to:
Department of Agriculture
or fax to (808) 483-7110
Animal Quarantine - Microchip Request
(credit card payments only)
99-951 Halawa Valley Street
NO REFUNDS
Aiea, HI
96701-5602
ALL SALES FINAL
COST: Microchip to Foreign Country Address
$27.00 each (U.S. currency)
_________________________________________________________________________________________________________________________________________________________________
Please print
OWNER: ________________________________________________________ Telephone: (_______) ______________
(Last name)
(First)
(MI)
NUMBER OF MICROCHIPS REQUESTED: _____________ X $ ______________ = $ ________________
Cost per microchip
Total Cost
Payment in advance required (Check one):
o
Money order, cashiers' check, or bank draft (Payable to Department of Agriculture). No Personal Checks.
o
Credit Card (complete the following information)
o VISA
o Mastercard
Name on Credit Card: __________________________________
Credit Card Number: ___________________________________
Expiration Date: _____________________
Signature: ___________________________________
PET INFORMATION (Complete for each microchip requested)
Pet's Name
Dog Cat
Breed
Sex
Age
Color
Markings
oo
1._________________
1. _________________________________________________________
oo
2._________________
2. _________________________________________________________
oo
3._________________
3. _________________________________________________________
oo
4._________________
4. _________________________________________________________
oo
5._________________
5. _________________________________________________________
oo
6._________________
6. _________________________________________________________
MAILING LABEL
(Print or Type)
TO:
_________________________________________________
Please fill out carefully.
The microchip will be mailed
_________________________________________________
to the address on the
mailing label.
_________________________________________________
The State is not responsible for
_________________________________________________
microchips lost or damaged
during shipment.