Center For Lab Animal Science

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:

mm/dd/yyyy

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:

  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

Housing Location:

Housing Duration:

Notes/Special Requirements: