Safe Deposit Submission Form

By filling in your details you confirm that you have read and agreed to abide by the Terms and Conditions for Safe Deposits at Culture Collections. Please also read the guide on How to Submit Safe Deposits for information on packaging and submission of samples.Prior to sending safe deposit samples please complete and submit this form and a Biohazard Risk Assessment Form. We will then contact you to advise you when we can receive your samples.

Name

Telephone Number

Collection

Street Address 1:

Street Address 2:

Street Address 3:

Street Address 4

Town / City:

State / Province / County:

Zip Code / Postal Code:

Country:

Deposit Type

Full Name of Deposit

Deposit Identification

This ID will appear on the safe deposit label

Number of Ampoules

GMO Category

This information is a legal requirement in accordance with the UK Health and Safety laws.

Do you want to add another line?

Yes
No

Full Name of Deposit

Deposit Identification

This ID will appear on the safe deposit label

Number of Ampoules

GMO Category

This information is a legal requirement in accordance with the UK Health and Safety laws.

Full Name of Deposit

Deposit Identification

This ID will appear on the safe deposit label

Number of Ampoules

GMO Category

This information is a legal requirement in accordance with the UK Health and Safety laws

If your invoice address is different than above, please enter is below:

Invoice Street Address 1:

Invoice Street Address 2:

Invoice Street Address 3:

Invoice Street Address 4:

Invoice Town / City:

Invoice State / Province / County:

Invoice Zip Code / Postal Code:

Invoice Country:

Security Check

Please Note: The Culture Collections must receive full information regarding delivery at least 48 hours before dispatch. Failure to do so could result in your shipment being returned unopened to you.

A Biohazard Risk Assessment Form must also be completed in order for your samples to be accepted. The Culture Collections is required to assess the GMO status of all deposits PRIOR to receipt. Therefore, we will contact all depositors to advise them when we can receive samples.

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Safe Deposit Submission Form

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