Primate Sales/Purchase Request Form

A. Contact Information
Investigator
Name:
Institution:
E-mail:
Phone:
Fax:
Billing Address
Address:
City:
State/Province*:
Postal Code:
Country:
Shipping Address
Address:
City:
State/Province*:
Postal Code:
Country:
Your Veterinary - Resources Group Contact
Name:
Phone:
E-mail:
B. Will the animal(s) be used for NIH-funded research?
Yes. Ongoing NIH Research.
Please supply the following information:
Grant Number :
Title:
Principal Investigator :
Total Amount of Grant:
Institute that Awarded Grant:
Yes. New Application for NIH Funding.
Please supply the following information:
Date :
Title:
Principal Investigator :
No. Funding for this research is from another source.
C. Animal information
Species:	Baboon Cynomolgus Rhesus macaque Other (Please Specify):
Sex and Quantity:	Male Female
Age:	Infant Juvenile Adult Geriatric Specific Age Range yrs
Weight Range:	kg
Naive?:	No Yes
Special Testing?:	Herpes Measles SIV SRV Viral Isolation Antibodies Other
Dates Animals Needed:	[MM/DD/YEAR]
D. Do you want this information for a quote or for a purchase?
QuotePurchase
E. If you have discussed this request with an SNPRC staff member, please provide a name.
SNPRC Staff Member Name:

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Phone
(210) 258-9400

Mailing Address
P.O. Box 760549
San Antonio, Texas 78245-0549

Shipping Address
7620 NW Loop 410
San Antonio, Texas 78227-5301