Research Models and Services Order Initiation Form

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Please fill out this Order Initiation Form in its entirety and click initiate order. Upon receipt of your order initiation, Harlan Customer Service will begin to process your request. A Harlan Customer Service Representative will contact you to gather all additional details required to place and complete your order.

Account Information

Account #:
(If known)
Region:

Contact / Shipping Information

*First Name: *Last Name:
Title: Department:
*Email: *Telephone:

*Company:
*Street Address: Street Address Line 2:
*City: *Postal/Zip:
*State:
* Province:
* Country:
* Country:

Shipping Address
Region:
Ship To Address: Ship To Address Line 2:
Ship To City: Ship To Postal/Zip:
*State:
* Province:
* Country:
* Country:

Order Information

Purchase Order #:
Product Species:
Product Model:
(Product Type - Nomenclature - Product Code)
Quantity:
Age / Weight:
Sex:
Add Surgical Modifications:
Surgical Comments:
General Comments
and/or Special Requests:

Current Shopping Cart

Species Model Qty Age/Weight Sex Surgical? Remove

Shipping

Requested Ship Date:
I have read and agree with the Harlan Warranty Information (Click to Read)


Additional order details will be gathered during order confirmation.

* Denotes a required field