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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.

Please note:

- The RRRC is a small repository and cannot typically accommodate requests for specific ages or weights, or requests for large numbers. 

- Please contact us for requests of 10 or more live animals.

- Animals shipped are normally from 4 weeks to 4 months of age.

- If a specific age- or weight-range is necessary, please state your needs in the Notes/Other Services section, and we will contact you to discuss.

Request Information

Institution/Organization

* Name:


* For Profit:


* Non-Profit:


* Will the materials being requested from the RRRC be used for commercial purposes?

* 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 # (If you have one):

Quote PDF:


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:

Please indicate courier and account number to be used for shipping

Courier:

Account Number:



* Name of individual officially authorized to approve shipment of animals into your facility:



* Email:
@

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 #:

if you have multiple order numbers please seperate them with a ","


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: