This form should be faxed to ECCAC prior to sending samples and the original must be included with the samples. A Biohazard Risk Assessment must be completed in order for your samples to be accepted. ECACC is required to asses the GMO status of all deposits prior to receipt. Therefore, we will contact all depositors to advise them when we can receive samples.
Name
Job Title
Company
Address
Post Code
Country
Telephone
Fax
Email Address
Purchase Order Number
Multilocus DNA - Fingerprinting / Multiplex PCR   Details of cell lines submitted:
1. Cell line name	Frozen    Growing
Suspected Species
If frozen details of medium for growth
Name and catalogue number of cell line to be compared to
2. Cell line name	Frozen    Growing
Suspected Species
If frozen details of medium for growth
Name and catalogue number of cell line to be compared to
3. Cell line name	Frozen    Growing
Suspected Species
If frozen details of medium for growth
Name and catalogue number of cell line to be compared to
Isoenzyme   Details of cell lines submitted
1. Cell line name	Frozen    Growing
Suspected Species
If frozen details of medium for growth
2. Cell line name	Frozen    Growing
Suspected Species
If frozen details of medium for growth
3. Cell line name	Frozen    Growing
Suspected Species
If frozen details of medium for growth