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訂購動物代收申請書(Collection Service Form)

代收對象:僅限公用動物設施的使用者-僅代收動物非入室申請

Object: Users in AScore ONLY.It's not the application for animal import.

所別(Institute) *

計畫主持人(P.I.) *

計畫主持人EMAIL *

提交此表時，系統會同時發信通知您及您的P.I.(We will send an email to inform you and your P.I.)

申請人(User) *

申請人EMAIL *

連絡電話(Phone) *

請留下動物送達當天可確實聯絡到申請人之電話 (Make sure write down the (cell) phone number of contact person that we can get through on the arrival day.)

手機(Cell phone) *

請留下動物送達當天可確實聯絡到申請人之電話 (Make sure write down the (cell) phone number of contact person that we can get through on the arrival day.)

動物基本資料(Animal Information)

請務必填寫一組動物資料才可送出此申請單。Please make sure to fill in at least a set of animal information before sending out this application.

抵達日期(Arrived date) *

月份

日

年

品系(Strain) *

出生日期(DOB) *

月份

日

年

性別與隻數(Gender-Number)

公-隻數(Male-No.) *

如不購買此性別請填寫0。If you don't order this gender, please fill in 0.

母- 隻數(Female-No.) *

如不購買此性別請填寫0。If you don't order this gender, please fill in 0.

來源(Source) *

動物基本資料 2(Animal Information 2)

請務必填寫一組動物資料才可送出此申請單。Please make sure to fill in at least a set of animal information before sending out this application.

抵達日期(Arrived date)

月份

日

年

品系(Strain)

出生日期(DOB)

月份

日

年

性別與隻數(Gender-Number)

公-隻數(Male-No.)

如不購買此性別請填寫0。If you don't order this gender, please fill in 0.

母- 隻數(Female-No.)

如不購買此性別請填寫0。If you don't order this gender, please fill in 0.

來源(Source)

動物基本資料 3(Animal Information 3)

請務必填寫一組動物資料才可送出此申請單。Please make sure to fill in at least a set of animal information before sending out this application.

抵達日期(Arrived date)

月份

日

年

品系(Strain)

出生日期(DOB)

月份

日

年

性別與隻數(Gender-Number)

公-隻數(Male-No.)

如不購買此性別請填寫0。If you don't order this gender, please fill in 0.

母- 隻數(Female-No.)

如不購買此性別請填寫0。If you don't order this gender, please fill in 0.

來源(Source)

需要代收事由(Reasons for the collection service) *

同意聲明(Consent) *

我同意以下聲明 I agree(不同意者，本設施不予受理申請)

1. 於動物送達七個工作天前，詳細填寫線上申請表並成功提交(系統會發信通知您與P.I.)。 2. 申請單上請留下動物送達當天可確實聯絡到申請人之電話。 3. 動物送達後，工作人員確認為代收動物後，會將動物置於生醫所後棟10F貨梯進入本設施後之推車上，請盡快前往領取。 4. 公用動物設施僅提供代收暫放服務，不進行任何處理，若動物開箱後有任何健康狀況疑慮由使用者自行負責。 1. Please submit the collection service form to AScore 7 days before animals arrive. 2. Make sure write down the (cell) phone number of contact person that we can get through on the arrival day. 3. Arrived animals will be placed on the cart inside the AScore after you take the No.7 elevator (for cargo use). PLEASE PICK UP ANIMALS AS SOON AS POSSIBLE. 4. AScore only provides collection service; The health status of animals is your own responsibility.

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