Assurance Number

Assurance Number Expiration Date

Is the customer’s facility accredited by AAALAC International - Yes No

Accreditation Number

Accreditation Number Expiration Date

Do you have an attending Veterinarian for this facility? - Yes No

Minimum requirement for receiving Live Mice is to have a veterinarian contracted by the institution. The veterinarian must have experience with laboratory mice, must visit the facility a minimum of twice yearly, must be available for veterinary emergencies, must hold a state veterinary license or has credentials consistent with graduation from a veterinary university/college. Husbandry of mice must be performed by trained animal care staff and the mice must receive daily welfare checks.

Will you be providing any type of service to another organization? - No Services Husbandry Services Toxicology or Therapeutic Testing Pathology or Imaging Other Service Not Listed Above

First Name

Last Name

Title

Phone Number

Email