A N I M A L R E Q U I S I T I O N F O R M
INVESTIGATOR INFORMATION
Protocol Name:
Protocol Number:
Date of IACUC Approval:
Principal Investigator:
Department:
Order placed by:
Date of Request:
Phone:
Fax:
Email:
Ordering Information
Vendor or Institution:
Request Delivery Date:
Species:
Rats
Mice
Guinea Pigs
Rabbits
Felines
Hamsters
Swine
Ferrets
Canines
Other
Age:
Weight:
Strain:
Mice CF-1
Mice Balb/C
Mice C3H
Mice C57BL/6
Mice DBA
Mice NU/UN
Rat Harlan SD
Rats Spague Dawley
Rats Wistar
Rats Long Evans
Rats Lewis
Other
Sex:
Female
Male
Number:
Special Requirements:
Housing Information
Building:
Room Number(if known):
Special housing need, handling, diets, watering, etc.
Animal Requisition
Form(Fill, save and
send to email)
