Animal Purchase Request - Southwest National Primate Research Center

A. Contact Information

Investigator

Name*

Institution*

Email*

Phone*

Fax

Billing Address

Billing Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Shipping Address

Shipping Address*

Same as Billing Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Your Veterinary - Resources Group Contact

Name*

Phone*

Email*

B. Federally Funded Research?

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

Yes
No

Grant Title*

Principal Investigator*

Agency/Institute that Awarded Grant*

Funding for this research is from*

Commercial

C. Animal information

Species*

Baboon
Marmoset
Indian-origin rhesus macaque

Sex*

Male
Female

Quantity (Male)*

Quantity (Female)*

Age Range*

Age Range Units*

Weight Range*

Format: 999.99 kg

Research Naïve Preferred?

Yes
No

Research Purpose*

Special Testing?

Antibody

Herpes B
Measles
SIV
SRV
STLV
Other

PCR

SIV
SRV
STLV

Other

Dates Animals Needed*

D. Purchase Request Purpose

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

New funding request
Funded project

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

SNPRC Staff Member Name

Comments

Southwest National Primate Research Center