Contact Name

Address Line 1

Address Line 2

Address Line 3

Address Line 4

Town

County

Post Code

Country

Tel No

Fax No

Email Address

BIOHAZARD RISK ASSESSMENT MUST BE ENCLOSED

The deposit is made in accordance with the terms of the Budapest Treaty 1977. I agree to abide by the conditions and regulations regarding the deposit of cell lines to ECACC.

Name

Date

Invoice Address

Address Line 1

Address Line 2

Address Line 3

Address Line 4

Town

County

Post Code

Country

VIRUS INFORMATION

Name in full

Abbreviated Name

Identification on Ampoules

Strain

Serological Type

Normal Host

Virus Titre Deposited

VIRUS PROPAGATION

Host cells (first choice)

Alternative Host Cells

Details of Host Cell Growth
(media, temperature, seeding density, growth factors etc)

Details of Virus Growth
(eg confluency of host cells, co-cultivation, moi, effects, time taken)

VIRUS STORAGE

Material stored
(eg supernatant, infected cell extract, viable infected cells etc)

Temperature and conditions

VIRUS ASSAY

Method
(enclose if necessary)

LITERATURE REFERENCES (if any)

ANY OTHER RELEVANT INFORMATION