Primate Sales/Purchase Request Form

Fields in *red* are required.

A. Contact Information

Investigator
Name:
Institution:
E-mail:
Phone:
Fax:
Billing Address
Address:
City:
State/Province*:
Postal Code:
Country:
Shipping Address
Address:
City:
State/Province*:
Postal Code:
Country:
Your Veterinary - Resources Group Contact
Name:
Phone:
E-mail:

B. Will the animal(s) be used for Federally funded research?

C. Animal information

Species:


Sex and Quantity:
Age Range:
Weight Range: kg
Research Naïve Preferred?    
Research Purpose:
Special Testing?:
Antibody PCR
Dates Animals Needed: [MM/DD/YEAR]

D. Is this purchase request for the purpose of submitting a funding request or has the funding already been awarded?

E. If you have discussed this request with an SNPRC staff member, please provide a name.

SNPRC Staff Member Name:
Comments: