Breeding Project Quote Request Form

Email:

First Name:

Last Name:

Organization:

City:

Country:

State:

Province:

Phone Number:

Interest Area:

Project Description:

Check this box if this quote request is an estimate for a grant application.

Grant application due date:

Designates required information

Strain Name:

Chromosome:

Sex-Chromosome

Autosomal

Transgene

Unknown

Type:

Chromosome Number:

Strain Background:

Please Explain:

In what form is the source mouse?

Are you able to provide a minimum of 2 males and 8 females?

Yes

What are you able to provide?

Age of Male mice: (Preferred age: 8-16 weeks)

Age of Female mice: (Preferred age: 6-12 weeks)

Are there any Breeding Difficulties and Special Breeding considerations?

Yes

Please Explain:

Quantity of Straws or Vials?

Embryos per Straw or Vial?

Aliquots per Straw or Vial?

Please enter the details of Cryopreservation Facility:

Please provide a freeze thaw protocol if available (or Email to jaxservices@jax.org at your earliest convenience) Only accept PDF/Word file of size less than 3MB

Genotype of Male Mice:

Please Explain : [Kindly provide the Gene Name and Genotype for each gene]

Genotype of Female Mice:

Please Explain : [Kindly provide the Gene Name and Genotype for each gene]

Genotype:

Please Explain : [Kindly provide the Gene Name and Genotype for each gene]

Would you like to have your Strain Background confirmed using JAX SNP analysis?

Yes

List all of the potential Strain Backgrounds which may be present (e.g. B6, 129) or indicate "Not Known"

Strain Name:

Chromosome:

Sex-Chromosome

Autosomal

Transgene

Unknown

Type:

Chromosome Number:

Strain Background:

Please Explain:

In what form is the source mouse?

Are you able to provide a minimum of 2 males and 8 females?

Yes

What are you able to provide?

Age of Male mice: (Preferred age: 8-16 weeks)

Age of Female mice: (Preferred age: 6-12 weeks)

Are there any Breeding Difficulties and Special Breeding considerations?

Yes

Please Explain:

Quantity of Straws or Vials?

Embryos per Straw or Vial?

Aliquots per Straw or Vial?

Please enter the details of Cryopreservation Facility:

Please provide a freeze thaw protocol if available (or Email to jaxservices@jax.org at your earliest convenience) Only accept PDF/Word file of size less than 3MB

Genotype of Male Mice:

Please Explain : [Kindly provide the Gene Name and Genotype for each gene]

Genotype of Female Mice:

Please Explain : [Kindly provide the Gene Name and Genotype for each gene]

Genotype:

Please Explain : [Kindly provide the Gene Name and Genotype for each gene]

Would you like to have your Strain Background confirmed using JAX SNP analysis?

Yes

List all of the potential Strain Backgrounds which may be present (e.g. B6, 129) or indicate "Not Known"

Strain Name:

Chromosome:

Sex-Chromosome

Autosomal

Transgene

Unknown

Type:

Chromosome Number:

Strain Background:

Please Explain:

In what form is the source mouse?

Are you able to provide a minimum of 2 males and 8 females?

Yes

What are you able to provide?

Age of Male mice: (Preferred age: 8-16 weeks)

Age of Female mice: (Preferred age: 6-12 weeks)

Are there any Breeding Difficulties and Special Breeding considerations?

Yes

Please Explain:

Quantity of Straws or Vials?

Embryos per Straw or Vial?

Aliquots per Straw or Vial?

Please enter the details of Cryopreservation Facility:

Please provide a freeze thaw protocol if available (or Email to jaxservices@jax.org at your earliest convenience) Only accept PDF/Word file of size less than 3MB

Genotype of Male Mice:

Please Explain : [Kindly provide the Gene Name and Genotype for each gene]

Genotype of Female Mice:

Please Explain : [Kindly provide the Gene Name and Genotype for each gene]

Genotype:

Please Explain : [Kindly provide the Gene Name and Genotype for each gene]

Would you like to have your Strain Background confirmed using JAX SNP analysis?

Yes

List all of the potential Strain Backgrounds which may be present (e.g. B6, 129) or indicate "Not Known"

Projects that include crosses between four or more strains require special planning to ensure an accurate statement of work. Upon submission of this request, a JAX® Services team member will discuss your breeding project needs with you.

Please be as detailed as possible with the project description above.

You may click the Edit Contact Information below to modify the project description above.

Deliverable Information:

Deliverable genotype	,	,
Do you need Tamoxifen injections?
Will accept mixed sex mice
Minimum number of mice required
Minimum number of male & female mice required	Male : , Female :
Accept an age range
Minimum & Maximum age in weeks	Min : , Max :
Age in weeks
Shipping requirements	, , shipments, Frequency :
Need Controls
Control type
Inbred strain
Need age match controls	Min : (weeks) , Max : (weeks)
# of control mice		Male : , Female :
Control genotype	,	,

BREEDING PROJECT QUOTE REQUEST FORM

Strain Information:

Deliverable Information:

Deliverable Information: