JAX-PGA Mouse Order

Please enter the exact shipping address for the animal facility that will receive your order, including the fax number for transmission of current health status report. Please also include your organization's purchase order number to process this order. All necessary information must be supplied before your order can be processed.

Academic institutions pay for shipping charges only; for-profit organizations will be charged $250.00 USD in addition to shipping charges. One breeder pair will be shipped unless otherwise indicated, and as availability allows.

Items in BOLD below are required fields.

Your Name (First/Last):

Organization:

Title:

Street:

City:
 State:
 Zip Code:
Country:

Phone:
 Fax:

Your E-mail Address:


Please note! - Check with your Purchasing/Shipping/Receiving Dept. for your Jax Customer ID; and to have a P.O.# to enter on this form. If your institution does not have a Jax Customer ID please fill out the New Customer Form before continuing with this order form.
Jax Customer ID number:

Shipping Details

Your institutional purchasing
department's P.O.# to process this order:

Shipping contact person,
if different from requesting Researcher:

Shipping contact phone number:

Your Animal Facility or
Shipping Dept. Fax number:

We want HLB#:
We'd like this many:
Affected only?(y/n):

Notes or comments regarding this order:

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Program for Genomic Applications (PGA)

Supported by the National Heart, Lung, and Blood Institute (NHLBI) (Grant # HL66611)