INTER-INSTITUTIONAL ANIMAL TRANSFER

Today’s Date______Requested Shipping Date______

Please complete form and submit request for shipping at least one week prior to requested shipping date

SHIPPING INSTITUTION

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P.O. or Ref. #

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Principal Investigator / Contact Veterinarian
Institution / Phone # / Fax #
Address / E-Mail
Facility Contact
City / Phone # / Fax #
State / ZIP / E-Mail
AAALAC Intl. Accredited ? / OLAW Assurance # / USDA Registration # / IACUC Approval #

RECEIVING INSTITUTION

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P.O. or Ref. #

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Principal Investigator / Contact Veterinarian / Kevin C. O’Hair
Institution / University of New Mexico, Health Sciences Center / Phone # / 505 272 3936 / Fax # / 505 272 9106
Address / Animal Resource Facility
915 Camino de Salud NE MSC08 4530 / E-Mail /
Facility Contact / Kristy Chavez
Christie Wilcox
City /
Albuquerque
/ Phone # / 505 272 3936 / Fax # / 505 272 9106
State /
NM
/ ZIP / 87131 / E-Mail /

AAALAC Intl. Accredited ? /
YES
/ OLAW Assurance # /
A-3350-1
/ USDA Registration # / 85-R-0014 / IACUC Approval # /

ANIMAL HANDLING INFORMATION

Quantity / Species / Strain / Sex / Weight / Age / # of Crates / Housing location at shipping institution / Housing location at receiving institution
BILLING INFORMATION
Courier / Health Certificate Charge
Courier’s
Phone # / Express Mail Charge
Airbill # / Veterinary Time Charge
¨ Bill Shipper
Account # / Technical Time Charge
¨ Bill Receiver
Account # / Crate Charge
Pick-up Date / Courier Charge
Delivery Date / Service Charge
Special Handling Instructions / Other Charge
TOTAL

Transfer of inbred, mutant, or gene targeted animals may require the completion of a Material Transfer Agreement prior to shipment. Contact your institution’s department of grants and contracts for information.