Cell Request Form

This form is for approved Stem Cell orders. If you have not been approved to use this form please contact the Stem Cell Core.

Please fill out this form to request a cell line. Please allow approximately two weeks lead time for your order to be available. You will be contacted 2-3 days before and on the day your cells are ready. A processing fee will be charged to your FAU on the day cells are ready for pick up, even if they are not picked up.

Indicates required field

First Name

Last Name

Phone Number

FAU

Cell Line Requested

Number of wells being ordered

Level of Cell Confluency Requested

I understand that all reasonable efforts will be made to contact me when my order is ready to be picked up. I agree to have my FAU charged in the event I do not pick up on the day that it is ready.

I accept this disclaimer

Stem Cell Center

Cell Request Form