Order Form

Please note the following:
1. Orders will be ready for pickup within 24 hours.
2. If mice are not picked up within 24 hours of their order, perdiem charges will start.
3. Double check the order. All orders are final!

Requestor Information
	Principal Investigator:
	Protocol Number:
	Requested By:
	Phone Number:
	Email:
	Box #:
	Account #:
	College:
	Department:

Order #1
	Strain Code:
	Age or Date of Birth:
	# Mice Required:	females males
	Inventory Cage # :	location in the colony
	Planed Pickup Date:	per diem charges start 24 hours after order
	Mice Disposition:	Pickup Move to Experiment Room Transfer to Animal Resources
	Additional Comments:

Order #2
	Strain Code:
	Age or Date of Birth:
	# Mice Required:	females males
	Inventory Cage # :	location in the colony
	Planed Pickup Date:	per diem charges start 24 hours after order
	Mice Disposition:	Pickup Move to Experiment Room Transfer to Animal Resources
	Additional Comments:

Order #3
	Strain Code:
	Age or Date of Birth:
	# Mice Required:	females males
	Inventory Cage # :	location in the colony
	Planed Pickup Date:	per diem charges start 24 hours after order
	Mice Disposition:	Pickup Move to Experiment Room Transfer to Animal Resources
	Additional Comments:

Order #4
	Strain Code:
	Age or Date of Birth:
	# Mice Required:	females males
	Inventory Cage # :	location in the colony
	Planed Pickup Date:	per diem charges start 24 hours after order
	Mice Disposition:	Pickup Move to Experiment Room Transfer to Animal Resources
	Additional Comments:

Order #5
	Strain Code:
	Age or Date of Birth:
	# Mice Required:	females males
	Inventory Cage # :	location in the colony
	Planed Pickup Date:	per diem charges start 24 hours after order
	Mice Disposition:	Pickup Move to Experiment Room Transfer to Animal Resources
	Additional Comments:


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