New Customer Application

1. Animal Welfare Information

What do you plan to order:
Product

Tissue collections, feces, TTCs, cryopreservation services

Live Animal

Including Custom Model Generation and Colony Management Solutions

If you are planning to design or breed your animal model with Taconic, but have not yet selected a CRO for shipment of live animals, please select that you plan to order "Products" and your Taconic account will be setup without live animal shipment options until you have selected a CRO and provide Veterinarian contact information.

Does your company own/manage or outsource animal husbandry vivarium?

Outsource Location:

Is the vivarium AAALAC accredited?

Does the vivarium have a committee or ethical review process to ensure humane animal care and use:

Do you have an attending vet or a consulting vet?

Attending / Consulting Veterinarian First Name:

Attending / Consulting Veterinarian Last Name:

Attending / Consulting Veterinarian Title:

Attending / Consulting Veterinarian Email:

Attending / Consulting Veterinarian Phone Number:

Special approval from Taconic Veterinary Science services is required to receive a live animal shipment.

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2. Company or Institution Information

Company or Institution Name

Country

Address Line 1

Address Line 2

City

County/Region/Province

State

Postal Code

Type of Business

Currency

Financial Classification

Organization Therapeutic Area

Website Address

Contact First Name

Contact Last Name

Contact Role

Email

Phone Number

Is the Shipping information the same as the Company/Institution information?
Yes

No

Prefered Method of Contact:
Email

Telephone

Research Location:
US

EU

CN

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3. Shipping Address Information

Company or Institution Name

Country

Address Line 1

Address Line 2

City

County/Region/Province

State

Postal Code

Shipping Contact First Name

Shipping Contact Last Name

Contact Title

Shipping Contact Email

Shipping Contact Phone Number

Vivarium animal receiving hours of operation

Special Delivery Instructions

Company or Institution Name

Country

Address Line 1

Address Line 2

City

County/Region/Province

State

Postal Code

Shipping Contact First Name

Shipping Contact Last Name

Contact Title

Shipping Contact Email

Shipping Contact Phone Number

Animal Receiving Contact First Name

Animal Receiving Contact Last Name

Animal Receiving Contact Phone Number

Animal Receiving Contact First Name

Animal Receiving Contact Last Name

Animal Receiving Contact Phone Number

Is the Billing information the same as the Company/Institution information?
Yes

No

Is the Billing information the same as the Shipping information?
Yes

No

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4. Billing Address Information

Company or Institution Name

Country

Address Line 1

Address Line 2

City

County/Region/Province

State

Postal Code

Billing Contact First Name

Billing Contact Last Name

Contact Title

Billing Contact Email

Billing Contact Phone Number

Annual Mouse/Rat Budget $/€

Tax ID/VAT Number

Tax Exempt (US ONLY):
Yes

No

(If yes, please provide document as a pdf, txt, or doc file no greater than 5mb in size)

Please provide invoice email address:

***Payment terms will be confirmed following review by Taconic's Finance Team***

Taconic needs the contact information you provide in this form to respond to your request. For details please see our Privacy Policy

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1. Animal Welfare Information

2. Company or Institution Information

3. Shipping Address Information

4. Billing Address Information

Products

Services

Order

Notices & Policies

Resources

Quality

Company