Rodent Quality Assurance Monitoring Program

Request to Export Rodents

To request exportation of rodents to outside institutions please complete this form and submit it using the button at the end.
You will receive a confirmation by Email.
The animals are usually shipped within one week. Animals will only be shipped if the receiving institution has approved the shipment.
Missing information may cause delays in sending out the animals.
The cost of exporting the animals, including incidental costs such as additional health testing, long-distance phone or fax charges, must be paid by the investigator and will be charged to the PTAEO provided.
As of July 1, 2008, the Export Fees that will be assessed for all Export requests are $75 for domestic shipments, $160 for international shipments. Your PTAEO will be billed at the time the request is made, regardless of whether the animals are ever actually sent. If you are sending mice from multiple rooms to the same location (in the same shipment), you will need to fill out a request for each room, but there will be only ONE fee charged- the requests will be combined administratively.

Species:

Strain:

Number of Animals:

	Gender: Age:
Present Location:	Facility: Room: Rack: Cage:

Number of Boxes required:

Sending Investigator:	Name:	Email address:
	Department:

Contact Person:	Name:	Phone:	Fax:
	Email address:

Investigator will pack animals

YARC will pack animals

Investigator:

Name:

Institution:

Shipping Address:		domestic
		international Country:

Shipping Contact:	Name:	Phone:	Fax:
	Email address:

Veterinarian:	Name:	Phone:	Fax:
	Email address:

	Sending Investigator	Receiving Investigator
Packaging:
Shipping:
	Charging instructions for sending investigator (REQUIRED) PTAEO #:	Charging instructions for receiving investigator (sending investigator will be charged if this information is not provided) Bax Global Acct # Emery Acct # World Courier Acct # other
Credit Card: Name on Card: Number: Exp:

Comments: