WUSM :: Mouse Genetics Core :: Request Forms :: Mouse Transfer/Shipping Request

WASHINGTON UNIVERSITY IN ST. LOUIS

SCHOOL OF MEDICINE

MGC

REQUEST FORMS

MOUSE TRANSFER/SHIPPING REQUEST

Request Forms | Mouse Transfer/Shipping Request

Items marked with * are required fields.

Primary Investigator...
	*Name (Last Name, First Name):
	*Department:
	*Institute:
	*Street Address:
	*City:
	*State/Province:
	*Zip/Postal Code:
	*Country:
	*Phone:
	*Fax:
	*E-mail:
Request Details...
	*Mouse Line Requested:

	*P.O. Number for Billing:	(Investigators will be invoiced for Cdn$750 (US$500). This fee covers the expense of sending the mice, including brokerage fees, health reports and shipping.)

Designated Lab Contact...
	Name (Last Name, First Name):
	Phone:
	Fax:
	E-mail:
Institutional Veterinarian/Authorized Shipment Approver at Recipient Institution...
	*Name (Last Name, First Name):
	*Title:
	*Phone:
	*Fax:
	E-mail:
Animal Resource Coordinator/Animal Shipment Contact...
	Unless informed otherwise, this individual's contact information will be specified on shipping documents
	Name (Last Name, First Name):
	Title:
	Phone:
	Fax:
	E-mail:
Live Animal Shipment Carrier...
	Preferred Carrier:
	Broker:
	Firm:
	Fax:
Ship to Address...
	Department:
	Institute:
	Street Address:
	City:
	State/Province:
	Zip/Postal Code:
	Country:
	Special Shipping Instructions:

Notes and Comments...
	Please indicate any additional information we might need to know which doesn't fit in any of the above fields:

Press the Send button ONCE to submit your information. Within 72 hrs of your request, you will receive a current health report faxed to your facility. After vet approval, we will make arrangements to ship the mice and you will be invoiced.

or TOP



	©2001-2005 Washington University in St. Louis, School of Medicine, Mouse Genetics Core webmaster@kids.wustl.edu \| reporting copyright problems \| 2004-09-16 09:46:11