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ASSURANCE STATEMENT PRF&L must have this assurance before initiating your project.
I give assurance that no biohazardous or radioactive materials, toxic, carcinogenic, infectious, or transmissible agents have been submitted to PRF&L for injection into animals. The animals injected are owned solely by PRF&L. However, all of the serum and products obtained from the animals will be the property of the project sponsor or PI. I assure that the information in this form is fully and accurately presented and that I have read and understood PRF&L’s disclaimer (www.prfal.com/disclaimer.htm). The USDA and NIH require that assurance be given that this request does not unnecessarily duplicate previous experiments.
I have read, understood and agree with the above statement. | I disagree, explanation attached. Date:


HOST
SPECIES

NUMBER PER
ANTIGEN
TOTAL NUMBER
REQUIRED1
PREIMMUNE BLEED SIZE2
RABBIT
GUINEA PIG
CHICKEN Pre-Eggs
GOAT
SHEEP
RAT
MOUSE
1 The number should equal the number of species/antigen times the number of antigens.
2 Two size bleeds are offered for rabbits large 15ml and small 4ml; one size for guinea pigs 4ml; chickens 10ml (also be sure to indicate how many preimmune eggs should be collected); there are three size bleeds for goats and
sheep large 200ml, small 60ml, and test 4ml; rats have one size 0.5ml; and mouse preimmunes are 0.2ml. If no preimmune serum is required indicate so by stating “None”. Please note prebleed volumes are approximate.

PREIMMUNE SCREENING SERVICE- If background titers that may be present in normal sera in species that you choose for antibody production is a concern, you may select our optional Preimmune Screening Service for an additional charge. Please contact us for availability and details of this service.

SERA STORAGE AND SHIPPING CONDITIONS
Store sera at -80 C and ship frozen with dry ice
Store sera at +4C and ship with ice packs
Store sera at +4C and ship at room temperature (lowest shipping cost)
Add 0.025% Sodium Azide to sera
Aliquot sera; indicate aliquot size (ml):
(There is an additional charge for aliquoting)

Please complete each box as applicable. Please contact us if you need advice on how to complete this section.
ANTIGEN NAME
NUMBER OF ANIMALS
AMT SENT (mg) 4 e.g. 10 X 0.1ml @ 0.1mg ea
CONCENTRATION (mg/ml)
FORM
TYPE
BUFFER
APPROX PURITY %
MOLECULAR WEIGHT
HUMAN/ANIMAL HEALTH HAZARD
ADJUVANT (default = Freunds)
PROTOCOL (default = Peptide)
ANTIGEN AVAILABILITY
STORAGE TEMP (default = +4 C)

ADDITIONAL INFORMATION - To assist you with your project goals, it would be helpful to know why you are producing custom antibodies. Also, you may indicate any additional or special antigen or sera handling or storage instructions, precautions, other procedures desired and/or details in order to help us provide you with the utmost custom antibody production service and a functional antibody in the end.

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