Custom Order Form

Custom Antiserum Service Protocol Information Sheet

Investigator Name
Contact Name*
Email*
Phone*
Fax
Shipping address*
Street AddressAddress Line 2CityState / Province / RegionZIP / Postal CodeCountry
Billing address
Street AddressAddress Line 2CityState / Province / RegionZIP / Postal CodeCountry
PO Number
Amount*
Animal Selected*
- Goat
- Sheep
- Llama
- Other
If other, please specify*
Total Number of Animals to be Used*
Name of Antigen*
Amount of Antigen*
Number of Doses of Antigen*
Signed (Investigator`s Name)*
The above Antigen is not infectious or harmful to the animal.
Date*
Is Sodium Azide (0.1%) to be added to the antiserum?*
- Yes
- No
Adjuvant: The initial immunization will be given in Complete Freund's Adjuvant (CFA) with all subsequent immunizations (boosts) given in Incomplete Freund`s Adjuvant (IFA).

Route of Immunizations: All immunizations will be made at multiple subcutaneous sites only.
Proposed Schedule
Day 0
Day 7
Day 14
Day 21
Day 28
Day 35
Day 42
Day 49
Day 56
Day 63
Day 70
Day 77
Day 84
Day 91
Day 98
Day 105
Day 112
Day 119
Day 126
Day 133
Day 140
Please attach your supporting claims that the antigen is not harmful to animals.
Comments
If the enclosed antigen is to continue an existing protocol, please list the animal numbers being used for this antigen.

Proposed Schedule