REQUEST FOR ORDER OF EXPERIMENTAL ANIMALS
DEPARTMENT OF LABORATORY ANIMAL RESOURCES
ROOM 113D - Ext. 6166

Animal Order form

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DATE _________________________________	Date of preparation
PR. INVESTIGATOR ____________________	P.I. on protocol
DEPARTMENT _________________________	P.I.s department
DEPT.REQ.NO. _________________________	Department's requisition number (if applicable)
PROTOCOL NO. _______________________	IACUC protocol number
ACCOUNT NO. ________________________	Account number must correspond to protocol number (see the New Account Memorandum)
ACCOUNT EXP. _______________________	Account's expiration date (Animals cannot be ordered to come in after the expiration of the Grant)
ON ARRIVAL NOTIFY _________EXT._____	Contact person's name and ext. (This should be someone usually available that knows about or works with the animals.)
COMMENTS TO BUYER ________________ ______________________________________	Include any additional information that you would like the buyer to know.

 

Species**	Quantity	Sex		Age or Weight	Strain	Date Required	Information for USDA -- Animal Usage
		M	F				A	B1	B2	C	D
Such as Mice, Rat or Gerbil. Please submit one order form per species.	Indicate the number of animals required on each shipment date.			Such as 11-12 wks old, 150-200 gm, or 20 days preg. Age and weight should be given as a range.	Such as Balb/C, Sprague-Dawley,  SCID, etc.	Arrival dates required for each shipment being requested.	This should match the animals' classification indicated in the protocol number.

 SPECIAL INSTRUCTIONS:

1. Is an ONLY SOURCE vendor required to assure experimental consistency?
   _Yes _No _If you have checked yes, please indicate the preferred vendor. The vendor must be an approved disease-free source.__
2. Will these animals be housed by _LAR Central Facility _IBT _IDD _McD _VA _Other? Indicate location where animals will be housed.
   1. How long do you expect to house them? ___________________
   2. Are animals to be housed in Biohazard Area? _Yes _No
      If yes, you must have a biohazard protocol and have completed biohazard training.
   3. Are animals to be used for _Chemical or _Radioisotope protocols?
      If yes, you must have In Vivo Radioactive Material Containment Evaluation Form from Institutional Safety or,
      If yes for Chemicals must have Application for Approval to Use Chemical Carcinogens.
3. If rats or mice, will these animals be taken to your lab during your lab during your research and returned to LAR? _Yes _No
4. If rats or mice, will they be recipients of:
   1. Human or rodent origin cells, tissues or products? _Yes _No
   2. Used in in vivo monoclonal antibody/hybridoma production preparation? _Yes _No
5. Will the animals be transgenic with special needs? Describe:________________________________________________________________________________
6. Do you have special equipment, housing or diet requirements? If so please contact the Animal Resources Manager at ext. 6166.

AUTHORIZED SIGNATURE_This must be the name and signature of a person authorized to sign for the account indicated above.__

Additional information:

• Per Diem Rates
• Request for Transfer of Experimental Animals
• Factors to Consider When Calculating Costs for the Purchase of Animals Under an Approved Protocol

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Animal Order form

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