Research Models Evaluation Request Form Thank you for your interest in Charles River Research Models. To expedite your request, please complete the form below and we will contact you as soon as possible: * indicates a required field Salutation Select Mr. Mrs. Dr. Ms. First Name * Please enter first name. Last Name * Please enter last name. Email * Please enter email. Please enter a valid email. Job title Department Company * Please enter company. Street Address * Please enter street address. City * Please enter city. State/Province * Please enter state. Postal/Zip * Please enter zip code. Please enter a valid zip code. Country * Select Country Albania Austria Belgium Bosnia-Herzegovina Bulgaria Croatia Czech Republic Denmark Finland France Germany Greece Hungary Ireland Italy Japan Korea Luxembourg Macedonia Montenegro Netherlands Norway Poland Portugal Serbia Slovakia Slovenia Spain Sweden Switzerland Taiwan United Kingdom Please select a country. Telephone * Please enter phone number. Please enter a valid phone number. Research area How did you hear about our program? Select Advertisement Postcard My sales representative A colleague Tradeshow ResearchGate Charles River website Other (please indicate) Yes, I would like to receive email communications from Charles River and allow for my information to be used for any follow-up requests to identify potential products or services relevant to my needs. I agree. To quickly expedite your request, please complete the form below and we will contact you as quickly as possible. Please indicate the following: Are you a current Charles River customer? Select Yes No What is your interest in evaluating these models? Select Assess the models in my current protocol Assess the models in a new protocol Conduct/fine-tune a pilot study Explore the opportunity to switch models Evaluate the Labstamp® identification method Take my research into a different direction Other (please indicate in comments below) Do you have an estimated date as to when you will require these models ? What would you like to evaluate? Select eval type Animal Models Surgically Altered Model Biospecimens Which species would you like to evaluate? Select species Mice Rats Hamsters Guinea Pigs Rabbits Which strain/stock of animal would you like to evaluate? Select strain Show just the Disease Models What surgical procedure would you like to evalute**? Select Vascular Catheterizations Non-Vascular Catheterizations Cardiovascular Procedures Neurological Procedures Soft Tissue Procedures Device Implants ** Certain restrictions may apply based on quantity, stock, strain or procedure requested. Select the surgical procedure Select the surgical procedure What Biospecimen would you like to evaluate? Select biospecimens option Tissues and Organs Blood Products Others Select the Biospecimen Additional Comments: