Sperm Cryopreservation Request


* = Required fields
* Strain name :
Link to existing Strain ID:

A strain must be submitted prior to requesting for cryo.
Provide the Strain ID to which this request should be associated with.
A record of the strain ID would have been emailed to you when the strain was submitted.
If the strain ID cannot be found, please contact phenbank@anu.edu.au for assistance


Researcher details
* First name:
* Surname:
* Email:
Phone:
Contact details

Emails will be sent to the main contact person. Alternate contact persons will be CC'ed
 Same as Researcher details
* First name:
* Surname:
* Email:
Phone:
Add alternate contact person
Animal Facility (where the strain is housed)
Are these mice housed within the
Hugh Ennor Building (ANU Bioscience Services)?		 Yes    No    Unknown   
* Name of facility:
Person responsible for packing and shipment of mice
 Same as Researcher details
* First name:
* Surname:
* Email:
* Phone:
*General mouse details
*Is this strain Genetically Modified as defined by the OGTR? Yes     No
Animal ethics approval number:
If you require extra samples to be taken (eg. liver or tail) it can be requested by emailing phenbank@anu.edu.au
*Mouse details

Please list younger mice first
Mouse ID Generation Date of Birth
(dd/mm/yyyy) 		Genotype Genotyping
samples
required?		 Coat
Colour		 Additional details




Yes     No






Yes     No






Yes     No






Yes     No






Yes     No


Additional details:
Services & Costs
Sperm Cryopreservation (Selected)
*Are you a for-profit client? Yes     No
In vivo QC Fertility test (optional) Yes     No
In vitro QC Fertility test (optional) Yes     No
Total Cost To be calculated when the request is saved
 Price List of Services 
Service Cost per strain (in AUD, exclusive of GST)
Mouse sperm cryopreservation for non-profit clients 468.56
Mouse sperm cryopreservation for profit clients 1405.7
In vitro QC Fertility test for internal clients 984.0
In vitro QC Fertility test for external clients 984.0
In vivo QC Fertility test for internal clients 1504.91
In vivo QC Fertility test for external clients 1852.2

Between 200 - 300 2-cell embryos will be cryopreserved with at least 60% viability rate and 70% development rate.
Billing details
* First name:
* Surname:
* PO Number:

of finance department
* Postal Address:

To avoid issues with invoicing please use the address acceptable to your finance department
* Investigator email:
* Institution accounts payable email:
* Phone:

 Terms and conditions 

* I acknowledge I will receive an invoice for this work from ANU finance department and will pay within 30 days of receipt.

* Please note your samples will either be processed at Monash or ANU.

* Should the APB be no longer able to provide storage of your cryopreserved samples, APB staff will attempt to contact you to offer to return the samples to you. If the APB is unable to contact you or you do not reply within the allocated time frame, the samples will be destroyed by incineration

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