"Johne's Disease Vaccine Order Form" - Iowa

Johne's Disease Vaccine Order Form is a legal document that was released by the Iowa Department of Agriculture and Land Stewardship - a government authority operating within Iowa.

Form Details:

  • Released on February 1, 2017;
  • The latest edition currently provided by the Iowa Department of Agriculture and Land Stewardship;
  • Ready to use and print;
  • Easy to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of the form by clicking the link below or browse more documents and templates provided by the Iowa Department of Agriculture and Land Stewardship.

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Download "Johne's Disease Vaccine Order Form" - Iowa

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a
Iowa Department of Agriculture & Land Stewardship
Bureau of Animal Industry
nd
Wallace Building, 2
Floor
th
502 E. 9
Street, Des Moines, Iowa 50319
515-281-5305
JOHNE’S DISEASE VACCINE ORDER FORM
Veterinarian: __________________________________________
Vet Code ______
Clinic Name: __________________________________________________________
Address: _____________________________________________________________
City, State, Zip Code: ___________________________________________________
Telephone: __________________________________
HERD OWNER: _______________________________________
ADDRESS: ____________________________________
CITY, STATE, ZIP: _______________________________
Johnes will only be shipped in quantities of 25 vials = 1 Carton
# of Cartons: _________ @ 171.75 a carton ($6.87 per vial) = $__________________
REMITTANCE PRIOR TO SHIPMENT – PRICES SUBJECT TO CHANGE WITHOUT NOTICE
PLEASE MAKE CHECKS PAYABLE TO THE IOWA DEPARTMENT OF AGRICULTURE & LAND STEWARDSHIP
**************************************************************************************************
IDALS OFFICE USE ONLY
DATE SHIPPED: _______________________
CLERK: __________________
Check Amount: $ ________________
Check #: ________________
Inventoried: Yes _____________
By: ____________
Revised: 02/2017
a
Iowa Department of Agriculture & Land Stewardship
Bureau of Animal Industry
nd
Wallace Building, 2
Floor
th
502 E. 9
Street, Des Moines, Iowa 50319
515-281-5305
JOHNE’S DISEASE VACCINE ORDER FORM
Veterinarian: __________________________________________
Vet Code ______
Clinic Name: __________________________________________________________
Address: _____________________________________________________________
City, State, Zip Code: ___________________________________________________
Telephone: __________________________________
HERD OWNER: _______________________________________
ADDRESS: ____________________________________
CITY, STATE, ZIP: _______________________________
Johnes will only be shipped in quantities of 25 vials = 1 Carton
# of Cartons: _________ @ 171.75 a carton ($6.87 per vial) = $__________________
REMITTANCE PRIOR TO SHIPMENT – PRICES SUBJECT TO CHANGE WITHOUT NOTICE
PLEASE MAKE CHECKS PAYABLE TO THE IOWA DEPARTMENT OF AGRICULTURE & LAND STEWARDSHIP
**************************************************************************************************
IDALS OFFICE USE ONLY
DATE SHIPPED: _______________________
CLERK: __________________
Check Amount: $ ________________
Check #: ________________
Inventoried: Yes _____________
By: ____________
Revised: 02/2017