Animal Purchase Request - Southwest National Primate Research Center

A. Investigator Contact Information

Name*

Institution*

Email*

Phone*

PI - Internal Accounting Contact

Name*

First Last

Can type N/A if not applicable

Email

Phone

PI - Sponsored Programs Contact

Name*

First Last

Can type N/A if not applicable

Email

Phone

Animal Import Coordinator

Name*

First Last

Can type N/A if not applicable

Email

Phone

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. Only enter numbers and with the format of 999.99, you would enter 30000 for 300kg

Research Naïve Preferred?

Yes
No

Research Purpose

Research Purpose*

Please type entries or paste plain text only. You can also add this as an attachment using the field below.

Research Purpose Attachment

Drop files here or

Max. file size: 50 MB.

Accepted file types: pdf, doc, docx, Max. file size: 50 MB.

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

Please type entries or paste plain text only. You can also add this as an attachment using the field below.

Additional Documentation

Drop files here or

Accepted file types: pdf, doc, docx, Max. file size: 50 MB.

Additional supporting documentation. PDF, Doc or Docx only

Southwest National Primate Research Center

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A. Investigator Contact Information

PI - Internal Accounting Contact

PI - Sponsored Programs Contact

Animal Import Coordinator

Billing Address

Shipping Address

Your Veterinary - Resources Group Contact

B. Federally Funded Research?

C. Animal information

Research Purpose

D. Purchase Request Purpose

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

Laboratory Core