The authorization number will be e-mailed to the address specified in this form.If you desire more than one strain, please complete a separate form for each of them. PART I: Requestor information Principal Investigator PI Name * PI Phone No * PI E-mail * Institute * Technion - Israel Institute of Technology Hebrew University of Jerusalem Weizmann Institute of Science Bar-Ilan University Tel Aviv University University of Haifa Ben-Gurion University of the Negev Ariel University Tel Aviv Sourasky Medical Center (Ichilov) Hadassah Medical Center Other Other Institute Contact Person Contact Name * Contact Phone No * Contact E-mail * Ethical Approval Number of Research * PI's from other institutes- Please also attach a copy of the approval letter Upload - More informationFiles must be less than 2 MB. Allowed file types: gif jpg jpeg png html pdf. Budget to be charged * * invoice will be sent after receiving of this filled form PART II: Description of requested procedure Desired background strain * Our standard default strain is C57BL/6JOlaHsd from Envigo (Harlan). According to customer's requirements other strains or hybrids could be considered. Target gene Expected Phenotype * Requested Manipulation * CRISPR/Cas9 knock-out and editing of mouse genome Mouse Embryonic Stem Cells injection for chimeric mice production Mouse DNA transgenes injections for Transgenic mice production Mouse sperm freezing and preservation In vitro fertilization from frozen/thowed mouse sperm Requested Manipulation - Other Do you have a designed sequence? (if yes please attach it) Upload - More informationFiles must be less than 2 MB. Allowed file types: gif jpg jpeg png html pdf doc docx ppt pptx. Requested destination of manipulated mice (after weaning) * All export and delivery fees are not included in the request quote. Additional Services *These services will be done at additional costs. Cryopreservation + IVF * Cryopreservation of either sperm or embryos enables you to save your colony in case of contamination and dramatically reduce costs associated with mouse colony maintenance, particularly of low use strains. Yes No Mouse and Blastocyst genotyping PCR service * It is recommended that the core perform genotyping of live-born offspring for the PCR will be performed on blastocyst and the resulting PCR products Sanger sequenced. Yes No Submitter Name * Submit
