Loyola Hall Vivarium Animal Order Form

Loyola Hall Vivarium Animal Procurement Form

Principle Investigator(s): ______Protocol Number: ______

Name of student(s):______

Name of Animal Vendor:______

Location: ______

Vendor Phone, FAX and/or email:______

Date of Animal delivery:______

Number of animals:______

Sex: ______age/size:______

How many days animals be housed______

Number of animals per cage: begining______end______

Type of food to be ordered: Meal, Pellets, or Special diet (specify) ______

Amount of food to be ordered______

Reminder: Food and bedding need to be in Vivarium before animals arrive.

Food Vendor: ______

Location of Food Vendor: ______

Vendor Phone, FAX and/or email: ______

Amount of bedding to be ordered______

Bedding Vendor information:______

(have been using Harlan Aspen Sani Chip bedding, rat or hamster cages about 22 cages/bag, 55 mice cages/bag)

Will this amount of litter last duration of protocol? Y or N? If not how often order needs renewal______.

Account(s) to be charged:______(if separate accounts for animals, food etc., please specify)______

Signature of Principle Investigator:______

Signature of Loyola Vivarium Director or Animal Caretaker: ______