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Receiving Investigator Request Form

Dear Investigator,

The information requested below is confidential and will be used to help ensure that rats are shipped to and used by organizations that have appropriate staff and housing to care for these animals.


Required information is marked with an asterisk (*). Please use "n/a" as needed.

Due to the small size of colonies maintained at the RRRC, we cannot typically accommodate requests for specific ages or weights of rats.  Animals shipped are between 3 weeks to 4 months of age.

Request Information

Institution/Organization

Name:


For Profit:


Non-Profit:


Tax Exempt #:

Investigator Contact Information

* Name:


* Phone:


Fax:


* Email:
@

RRRC Product Use Limitations

Any recipient of rats or other material from the RRRC agrees to the terms and restrictions of the RRRC Outgoing MTA. Recipient and institutional official must execute the RRRC Outgoing Material Transfer Agreement (MTA) before the request will be approved.

Animals/Materials Requested (quantities are limited)

Quote Number (If Applicable):


RRRC Catalog # - Strain:


Product:



Notes/Other Services:

Please list other services to be performed in the box to the left.
Please include the strain name in your request for services.
Other Services Available are:
- Cryopreservation
- Cryo-resuscitation
- Rederivation
- Genotyping
- Microsatellite Analysis
- Cytogenetic Analysis
- Rat Tissues
- Timed Pregnant Rats
- Microbiota Characterization

Shipping Information for Animal Facility

Name/Organization:


Contact Name:


Contact Phone:


Contact Email:
@


Address:


City:


State/Province:


Zip/Postal Code:


Country:

Billing Information

Billing Information is the same as shipping


Institution/Organization:


Contact Name:


Contact Phone:


Contact Email:
@


Address:


City:


State/Province:


Zip/Postal Code:


Country:


Purchase Order #:

Attending Veterinarian for Animal Shipment Authorization

Animals will not be shipped until the RRRC receives authorization for animal receipt by the receiving investigator's institution.

Name:


Phone:


E-Mail:
@

Additional Contact Information For This Request

Name and email address: