Animal Request Form
*Please submit one animal request for each arrival date*
Recharge # (4-char or DaFIS)(Required)
Protocol Number(Required):
Protocol Expiration Date(Required):
mm/dd/yyyy
Today's Date:
Infectious?
Yes No
Protocol Investigator:
Requested By:
School/Dept:
Phone(Required):
Fax:
E-mail(Required):
Quantity:
Gender:
Male Female Either
Species:
Strain:
Stock Number (Jackson lab orders)
Weight Range/Age:
Date Needed:
1st Choice Vendor:
Charles River Covance Harlan Indianapolis Harlan San Diego Hilltop Harlan Hog Barn Goat Barn Jackson Laboratories Jax West National Institue of Aging National Institue of Health Taconic Other-Specify in notes below
2nd Choice Vendor:
Housing Location:
Housing Duration:
Notes/Special Requirements: