Interstate Health Certificate request

Interstate transport of your horse requires an inspection and documentation of your horse's general health. A certificate of negative Coggins test is required as well. Please fill in the form and submit it so that we may accurately complete your document and expedite issue to you following your inspection appointment. Certificates can only be issued within 10 days after a physical inspection of your horse and are valid for 30 days from the date of inspection.

I am a(n):

Existing Client

New Client

Name

Owner

First Name

Last Name

Email Address

Horse's Name

Owner Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Owner Telephone Number

Origin

Person or Farm Name where your horse resides if not at owner

First Name

Last Name

Origin Address

where your horse is stabled; if same as owner, enter "owner"

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Origin Telephone Number

Destination

Person or Farm Name

First Name

Last Name

Destination Address

Where you are shipping your horse. No P.O. Boxes, horses won't fit in them

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Destination Telephone Number

Shipper Name

Enter third party shipper information; otherwise enter "owner"

First Name

Last Name

Shipper Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Shipper Telephone Number

Coggins Test

required, usually within ONE YEAR of transport date

Yes, current; can provide electronic or paper copy

No; lost, need new one; what's a Coggins?

Date of Shipment/Travel

YYYY