Charles River: Research Models and Services: Genetic Testing Services: Genetic Testing Submission

Research Models and Services

Genetic Testing Submission

* First Name:

* Last Name:

* Email:

Title:

Department:

* Company:

* Street Address:

* City:

* State:

US
Non-US

* Postal / ZIP:

* Country:

* Telephone:

Fax:

* Denotes a required field

Account Payable Bill To Address:
Same as Send to
Institution:
* Address:
Attn:
Email:
Tel:
Fax:

* Payment:

Purchase Order Number:
Credit Card

If paying by credit card, a representative will contact you for complete information.

Species:

Mouse Rat Zebrafish
Other:

Sample type:

Ear Tail Other

Date samples were shipped:

Total number of samples submitted:

If using Charles River Genotyping Kits, please complete the well plate location:

Date: Plate:

Strain/Line:

Row: