Please note -All the details below will be used to organize the official papers and you cannot change them without updating the coordinator.When the shipment is approved, shipping date will be coordinated by the Import-Export coordinator. Principal Investigator Name * Department * Tel * Cell Phone * E-mail * Contact Person Name * Tel * Cell Phone * Contact Person E-mail * Billing Please choose one of the following options for billing: * Charge the budget from the Animal Facility system. Charge the budget from this form. Charge the recipient * please note that there will be also an administration fee charge. * Please note that if the recipient will not pay within 45 days, your budget will be charged automatically. * For estimated charges (export, boxes for shipment etc.), please contact the ABBM office - 88465. Budget Number: * Name of Payer: * please attach a confirmation from the recipient. * Upload More informationFiles must be less than 3 MB. Allowed file types: gif jpg jpeg png html pdf doc docx ppt pptx. Address for sending invoice: * Collaborating Principal Investigator Name * Full Address * Tel * E-mail * Contact Person Name * Tel * E-mail * Description of Animals Please fill in the chart with the specific characteristics per each similar group of mice: Strain / Line: * Sex * male female No. of animals - male: * No. of animals - female: * Background (If the strain is Tg, KO etc.) Color Age * Add another animal type Add animals 2 Description of Animals 2 Please fill in the chart with the specific characteristics per each similar group of mice: Strain / Line: * Sex * male female No. of animals - male: * No. of animals - female: * Background (If the strain is Tg, KO etc.) Color Age * Add another animal type Add animals 3 Description of Animals 3 Please fill in the chart with the specific characteristics per each similar group of mice: Strain / Line: * Sex * male female No. of animals - male: * No. of animals - female: * Background (If the strain is Tg, KO etc.) Color Age * Add another animal type Add animals 4 Description of Animals 4 Please fill in the chart with the specific characteristics per each similar group of mice: Strain / Line: * Sex * male female No. of animals - male: * No. of animals - female: * Background (If the strain is Tg, KO etc.) Color Age * Add another animal type Add animals 5 Description of Animals 5 Please fill in the chart with the specific characteristics per each similar group of mice: Strain / Line: * Sex * male female No. of animals - male: * No. of animals - female: * Background (If the strain is Tg, KO etc.) Color Age * Total number of groups/cages * shipping boxes will be ordered accordingly. Animals should be sent as they are grouped in the cages - do not mix animals from different cages. Breeder pairs should be sent separated. Pregnant females or females with pups will not be sent without an approval from the Vet. Location (Facility) from which the mice are sent (Unit and room #): * Please mark the cages that you plan to send with the special cage card before sending this form. Name of Animal caretaker: Special Phenotypic characters which requires special handling: Comments: Note: An updated health report should be sent to the attending veterinarian of the receiving institute, please attach a written approval from him/her to receive the shipment. No animals will be shipped until receiving the written approval. Additional files - if needed, press to open. File Description Upload file1 More informationFiles must be less than 3 MB. Allowed file types: gif jpg jpeg png html pdf doc docx ppt pptx. Add another file add file File Description Upload file2 More informationFiles must be less than 3 MB. Allowed file types: gif jpg jpeg png html pdf doc docx ppt pptx. Add another file add file File Description Upload file3 More informationFiles must be less than 3 MB. Allowed file types: gif jpg jpeg png html pdf doc docx ppt pptx. Principal Investigator (in The Hebrew University) : Name (as electronic signature) * Date * Day12345678910111213141516171819202122232425262728293031 Day MonthJanFebMarAprMayJunJulAugSepOctNovDec Month Year20232024202520262027 Year Fill for GEMM only: Project Number Submit
