| Strain Name: |
B6.129-Krastm4Tyj |
| Strain Number: |
01XJ6 |
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To place an order, please fill-out the following information,
tab between fields, and click the submit button.
* Denotes required fields.
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| Number of Breeder Pairs:
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If this is
NOT your first order with the MMHCC Repository, has
any of the contact or shipping information changed since your last
order?
No
Yes |
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Recipient Scientist
(Investigator who will use these mice for research purposes) |
| First Name: |
* Last Name:
* |
| Institution: |
* |
| Institution Type:
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Recipient Scientist contact information only! (Not animal facility information) |
| Street 1: |
* |
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| Street 2: |
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| City: |
*
State:
Zip:
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| Country: |
(if non-U.S.) |
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| Phone: |
*
Fax:
* |
| Email: |
* |
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| Confirm Email: |
* |
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Authorized Recipient Official
(Person who will sign the MTA) |
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All orders from the MMHCC Repository are governed by Material
Transfer Agreements. To receive mice you must provide an MTA, which
must be signed by an authorized official representing your institution
(e.g., technology transfer officer, grants/contracts administrator).
After submitting the on-line
order form, you will be brought to a confirmation page which has a link to the Material
Transfer Agreement (MTA) for this particular mouse model.
Please indicate the authorized recipient official at your institution:
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| First Name: |
*
Last Name:
* |
| Job Title: |
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| Phone: |
* Fax:
* |
| Email: |
* |
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If individual(s) other than the Recipient Scientist
and Authorized Recipient Official should receive the MTA for this order,
please list their e-mail address(es) below:
Additional e-mail(s) for MTA: |
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Contact Person in Your Institution |
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Please indicate whom we should contact in your institution for shipping
arrangements and/or authorization to transfer mice.
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| First Name: |
* Last Name:
* |
| Institution: |
* |
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| Phone: |
* Fax:
* |
| Email: |
* |
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| Confirm Email: |
* |
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Shipping Information |
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Check here if shipping information is same as requestor's
information. |
| First Name: |
*
Last Name:
* |
| Institution |
* |
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| Street 1: |
* |
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| Street 2: |
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| City: |
*
State:
Zip:
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| Country: |
(if non-U.S.) |
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| Phone: |
*
Fax:
* |
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Special Delivery
Instructions: |
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The recipient is responsible for transportation fees.
Below is a list of authorized live animal delivery services.
Please select either 'Domestic Shipping' or 'International Shipping' below,
select a carrier, and provide the account number to be charged.
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Domestic Shipping OR
International Shipping *
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*
*
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| COURIER ACCOUNT #: |
* |
Click the "Submit Order" button to complete your order. |
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