Fill and Sign the Purchase Order Terms and Conditions Template Form

Rev. 7/3/03 CHECKLIST FOR 30-DAY QUARANTINE PROGRAM All steps need to be completed in order to qualify for this program. If you are unable to meet the following requirements your pet will undergo 120 days quarantine. Step 1 VACCINATIONS 1 My pet has been vaccinated at least twice for rabies in its lifetime. 1 The vaccines were administered more than 90 days apart. 1 The most recent vaccination was done: 1 not more than 12 months prior to my pet’s date of arrival in Hawaii for 1-year rabies vaccine or 1 not more than 18 months prior to my pet’s date of arrival in Hawaii for 3-year rabies vaccine. and 1 not less than 90 days prior to the date of arrival in Hawaii. 1 The date and type of vaccine must be indicated on the pet’s vaccination and health certificates. Most Recent Vaccination Date: ______ _____ Type of vaccine (check): 1 1-year or 1 3-year Previous Vaccination Date: ______________ Step 2 MICROCHIP (Microchip number: _______________________) 1 My dog or cat has an electronic microchip implanted. (Required before an OIE-FAVN rabies blood test is performed). 1 The microchip can be read by a standard US issue AVID ® scanner (AVID ®, HomeAgain®) and my veterinarian has verified this by scanning the chip. 1 I understand that if my pet cannot be identified with a scanned microchip it will not qualify for the 30-day quarantine program and will be assigned to 120 days quarantine instead. Step 3 OIE-FAVN RABIES BLOOD TEST (Lab receive date: ____ _______ Test result:___________) 1 The day after the laboratory received the blood sample is not more than 18 months and not less than 90 days prior to the date of arrival in Hawaii. 1 The result of my pet’s blood test was greater than or equal to 0.5 IU/ml. 1 The test was done at an approved lab (Kansas State University or the Food Analysis and Diagnostic Laboratory in Texas) 1 I have a copy of this successful blood test result showing my pet’s microchip number. Ask your submitting veterinarian for a copy of the results. Do not contact the laboratory directly. Step 4 WAITING PERIOD WARNING! Arriving anytime before the 90-day waiting period has elapsed will result in disqualification of a pet from the 30-day quarantine program. IMPORTANT: The waiting period begins on the day after the blood sample for the OIE-FAVN test is received by the laboratory. The test must also have a result > 0.5 IU/ml. 1 I understand that if my pet has not completed the 90-day waiting period before arriving in Hawaii my pet will not qualify for the 30-day quarantine program and will undergo 120-day quarantine instead. Step 5 DOCUMENTS 1 I have original signature or carbon copy of rabies vaccination certificates for the two most recent rabies vaccinations my pet received. (Photocopies are not acceptable) 1 The vaccination certificates have the vaccine name, lot or serial number, booster interval, vaccination date and expiration date listed. 1 I have an original health certificate in English, which was done within 14 days of arrival in Hawaii including rabies vaccine name, lot or serial number, booster interval, vaccination date and expiration date. 1 My vet has treated my pet for ticks with Fipronil or an equivalent long-acting product (Revolution® is not acceptable) within14 days of arrival and the product name and date of treatment is recorded on my health certificate. Step 6 RECOMMENDED SUBMISSION OF DOCUMENTS (Date Documents Sent:_____ _____) (Send documents and payment to: Animal Quarantine Branch, 99-951 Halawa Valley Street, Aiea, Hawaii 96701.) 1 1 1 1 I have allowed necessary delivery time to ensure documentation is received by the Animal Quarantine Branch more than 10 days before my pet is scheduled to arrive in Hawaii. Required Documentation: 1 My completed Document Submittal Form (form AQS-78). 1 My original rabies vaccination documents with original signature. 1 My completed Pet Owner Statement (form AQS-2 must be notarized). 1 I have paid my fees ($655.00) by cashier’s check or money order (no personal checks are accepted). I have included my pet’s microchip number with my payment to ensure proper credit. Payable to: Department of Agriculture. I may still pay at the Animal Quarantine Station. Payment by cashier's check or money order is recommended for faster processing. VISA, MasterCard, traveler’s checks and cash will also be accepted upon arrival, but may delay processing time. My payment will be made in full (exact amount preferred). I understand that change will only be given for payments made in cash. All other accepted methods of payment in excess of fees will receive refunds through the mail. I have copies of necessary qualification documents (health certificate, rabies vaccination records, and blood test result) for myself and to accompany my pet. If I didn’t send my original health certificate to the Animal Quarantine Branch in advance of my pet’s arrival, I will provide it upon arrival. Step 7 OTHER 1 I understand that before my pet may be transported to an approved veterinary hospital or satellite quarantine station on Maui, Kauai or the Big Island of Hawaii, it is my responsibility to provide an FAA-approved hard-sided pet carrier appropriate for my pet to travel in. 1 I understand that I will be assessed an additional $18.70 each day my pet stays at the Animal Quarantine Station beyond its scheduled release date of 30 days.