New Customer Application

1 Animal Welfare Information

Do you plan to order:

tissue collections, feces, TTCs, cryopreservation services

including GEM-D and GEM-M services

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

Is the vivarium AAALAC accredited? *

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

^*You are missing some required information above. See highlighted fields.

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 *

Contact First Name *

Contact Last Name *

Title *

Email *

Phone Number *

Fax

Preferred Method of Contact: *

Email

Fax

Telephone

Preferred Customer Service Location: *

US

EU

CN

Click the previous step title to review

^*You are missing some required information above. See highlighted fields.

3 Shipping Address Information

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

Company or Institution *

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 *

Shipping Contact Fax

Vivarium animal receiving hours of operation *

Special Delivery Instructions

Add an additional shipping contact? +-

Company or Institution

Country

Address Line 1

Address Line 2

City

County/Region/Province

State

Postal Code

Shipping Contact First Name

Shipping Contact Last Name

Shipping Contact Email

Shipping Contact Phone Number

Shipping Contact Fax

Click the previous step title to review

^*You are missing some required information above. See highlighted fields.

4 Billing Address Information

Is the Billing information the same as the Shipping information?

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

Company or Institution *

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 *

Billing Contact Fax

Scandinavian EAN# *

Annual Estimated Purchasing $/€ *

Tax Exempt (US Only):

Yes

No

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

Invoice Distribution Method: *

Mail

Email

***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.

^*You are missing some required information above. See highlighted fields.

Customs Broker Information

First Name *

Last Name *

Address Line 1 *

Address Line 2

City *

Province *

Postal Code *

Contact First Name *

Contact Last Name *

Contact Phone Number *

Contact Fax

Contact Email *

Comments

^*You are missing some required information above. See highlighted fields.

1 Animal Welfare Information

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

2 Company or Institution Information

3 Shipping Address Information

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

Add an additional shipping contact? +-

4 Billing Address Information

Is the Billing information the same as the Shipping information?

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

Customs Broker Information

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

Contact Us here.