ࡱ> ] Rܙbjbj::Xd(\Xd(\f!< < $P3t*4{^mmm8  13333333333333$69bW3@W3mm3***mm13*13**r1TG2m'*+2330*492:(:G2G2&:m2*W3W3**4:< I :  \lev(u7b `}Y ^8^ؚtQ` bNATCCvNT \O:NATCC(W-NV'YFTo0W:Svr[~FU bNyb gR:N,g Bl[ vlQS[e NQPYt^ gRNyYeT]NON(u7bvZW[W@x O geO g_wc g gO v\ATCC NT`vKb-N0 (W`'KNMR _{(WATCC^ze(u7b^7b03ue^7b@bPgeY N 3uUSMObfN The certificate of Commitment (DN1) e^7b3uh New Account Application form NekXQ DN2 [[c Description of laboratory cN-NeTe$NyHr,g USMO{N Description of laboratory facility cN-NeTe$NyHr,g uir[hQ[[D(fThe biosafety certificate of laboratory (cO-NV?e^蕁S~3uUSMOv[[uir[hQI{~fNbGMPfN YpSN 傡l gdk$NyfN (u-NekXQDN3uir[hQ[[D(f) lQS'`(v3uUSMO%Ngbgq0~~:ggNxTzR{v N YpSN0 NPgehQ萠Rv3uUSMOlQz \ck,g[blQS Nb0W@W TecN5uP[eN HYPERLINK "mailto:atcc@sinozhongyuan.com" atcc@sinozhongyuan.com0Yg`(WQY3uPgeǏ z-N gNUOu5u400-810-0881bSN0R  HYPERLINK "mailto:atcc@sinozhongyuan.com" atcc@sinozhongyuan.com 06e0R`v3uh Yg؏eEQPge bNOǏE-mailb OwN`T|0 6eN0W@W lQS Ty: SN-NSTZ~8 gPlQS lQS0W@WSN^g3:SNeN11S  100125 5u݋400-810-0881 0086-10-84415678 Ow0086-10-84415679 DN103uUSMObfNThe certificate of Commitment bUSMO(WATCC3u^ze&7b hQ3uDecN`QY N wQSOQ[DN0bUSMOb@bcNDebeN YpSNhQ萅Q[w[ NX[(WZGPbw`Q0 ^ScNDe Ty/f&TcNYl13uUSMObfN /f% &T%02e^7b3uh /f% &T%03[[c /f% &T%04USMO{N /f% &T%05uir[hQ[[D(fbf/f% &T%06%Ngbgq YpSN/f% &T%07~~:ggNx YpSN/f% &T%08zR{v YpSN/f% &T%0 3uUSMO Ty 3ueg USMOlQz DN20e^7b3uh ATCC _7b3uhkXQf It is important that all sections of the application be completely filled out or the review process will be delayed. Please take notice of the bullets below: [te~vkXQ3uhvk*NR/fASR͑v &TR3u\O^0laN Nc:y0 All names are complete with first & last names. @b gv TW[ g[tevY T0 Complete billing address: You will be required to verify this information before we can process any telephone, fax or email orders. [tev/eN^USv0W@W(WbNYt5u݋0 OwbEMAIL[USMRBl`ONw8h[0W@WOo` Product Use: How do you plan to use ATCC's product NT(uQf`ONYUOO(uATCCvNT0 Description of laboratory facility: HOW do you meet the requirements established by the CDC? See  HYPERLINK "https://www.cdc.gov/od/ohs/biosfty/bmbl4/bmbl4s3.htm" https://www.cdc.gov/od/ohs/biosfty/bmbl4/bmbl4s3.htm for additional information and assistance. [[YcQf`ONv[[YUO0RCDCĉ[vBlSNNN NQ@W_0R~vOo`NOSR0 Circle which BioSafety Containment Level of Facility you are requesting. Circle BSL-1 (Non Hazardous), BSL-2 (Moderately Hazardous) or BSL-3 (More Hazardous) (u W lf`ON0Rvuirxvz[hQ'`I{~0 W1eqSi'` W2N,qSi'` W3qSi'` BioSafety Officer-print the complete first & last name and signature. (We are not able to accept electronic signature.) uirxvz[hQ'`{tXTSbpS[tevY Tv^Kb~{bN NcS5uP[~{ T 0 Complete Shipping address: Ultimate laboratory destination of ATCC product. [tev0R'0W@WQfATCCNTvg~[0W@W0 End User/Investigators  who will be using the materials purchased from ATCC? g~(u7bQfO(uATCCNTvNXTv[tevY T05u݋0 OwSEMAIL0W@W0 Include a detailed company profile/description of your company on your organization s official letterhead/stationary. (This is a sheet of paper with your organization s name professionally printed or stamped somewhere on the paper.) (uUSMOck_v&^ gUSMOb4YvlQe~SbpSUSMO{N\O:N3uvDN 0 Include email address of contact person & researcher, if available. We confirm all orders automatically by email. lfT|NvEMAIL0W@W bN\ǏEMAILnx@b gvUSOo`0 New Account Application e^7b3uh New accounts are subject to approval. Please include an institution profile and biosafety description (described below) on company letterhead with your completed application. Your account application must be approved before any order will be processed. Missing information will delay approval or may result in denial of the application. Print or type information to be legible. (u7b_{3u^7b0cN3uPgee TecN(u`OUSMOb4Y~SbpSvUSMO{NTuir[hQc0S gybQ^7bTMb'03uPgeOo` NhQSO^ybQbb~0O@bcODenpf0 Please allow 7 to 10 work days after receipt of completed application for account approval. 6e0R[tev3uPgeT ^7bybQ7-10*N]\Oe0 Organization Name:gg TyWeb Site AddressQ@W Controller/Finance Officer Name#NY TTelephone5u݋Fax OwE-mail{ Billing Address (Invoices will be sent to this address.)N>k0W@W Please check with your accounts payable department to verify the correct billing address for your organization.Billing Department N>k Contact Person (Complete First & Last Name) T|NEmployer Identification Number (EIN) NS Street Address/P.O. 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N  044 laf4))))xsm$If$a$kdd $$If40F\ l) j0    44 laf4))P***/+|+  $Ifmkd $$If)B*   044 lap *++ ++++/+0+M+N+{+}+~+++++xhx|x(zzzzzzzz({,{4{6{T{V{v{z{{{{{|||||֛֛֨֨֨֨֨֨vv"jh5CJOJQJUaJ$h>*CJOJQJaJnHo(tHh>*CJOJQJaJ!hCJOJQJaJnHo(tH$h5CJOJQJaJnHo(tHUhCJaJhCJOJQJaJ joh5CJOJQJaJh5CJOJQJaJ-|+}++++zx=;5$If^kd$$If)B*044 la$If^kd$$If)B*044 la Acknowledgment of ATCC Material Transfer Agreement NTlOSnxBY SIGNING BELOW, I, THE DULY AUTHORIZED REPRESENTATIVE OF THE INSTITUTION AND THE END USER, ACKNOWLEDGE THAT I HAVE READ AND UNDERSTAND THE ATCC MATERIAL TRANSFER AGREEMENT AND AGREE TO ITS TERMS AND CONDITIONS. USMO#NbcCgNh(W Nb~{W[nx ]~N~Tt㉆NATCCvMTAOS v^ Tau_OSvTyag>k0 Printed Name Y T___ _______________ Position/Title LMO_____ _____ Signature ~{ T______________________ Date eg_______________________ Your can find the full MTA document on our Web site at  HYPERLINK "http://www.atcc.org" www.atcc.org and  HYPERLINK "http://www.sinozhongyuan.com" www.sinozhongyuan.com . `SN(WATCCT-NSlQSvQz Ng0RMTAOSeN Institution/Company ProfileUSMO{NInclude a brief description of your organization on company letterhead with your completed application. (uUSMOb4Y~QYUSMO{NProduct Use NT(uPlease give a general description of how ATCC products will be used. QfO(uATCCNTv;`SO(u  Laboratory Facility Description [[cOn your institution s letterhead, describe in detail how your lab facilities, access policies, material handling procedures, and training practices fulfill the criteria established for biosafety level guidelines by the CDC/NIH in chapter III of Biosafety in Microbiological and Biomedical Laboratories (BMBL), 4th edition, HHS Publication # (CDC) 93-8395. U.S. Department of Health and Human Services, Centers for Disease Control, Washington, D.C. Government Printing Office, 1999. The entire text is available online at  HYPERLINK "http://www.cdc.gov/od/ohs/biosfty/bmbl4/bmbl4s3.htm" www.cdc.gov/od/ohs/biosfty/bmbl4/bmbl4s3.htm . (uUSMOb4Y~Qf[[]~0RCDCĉ[vuir[hQ~+R0c-NSb[[[hQY0{tagO0uirTYt z^TNXTW6R^0(W  HYPERLINK "http://www.cdc.gov/od/ohs/biosfty/bmbl4/bmbl4s3.htm" www.cdc.gov/od/ohs/biosfty/bmbl4/bmbl4s3.htm Q@W Ng wCDCuir[hQ~+RvhQ0 The current biosafety containment level of your facility (circle one): 1 2 3* (W`OUSMOs(W[hQ~+R N;uW0 This will identify what biosafety level of ATCC materials can be safely received by your organization. ُ\f`OUSMO[hQcSATCCNHN[hQ~+RvNT0 *Level 3 will require the curriculum vitae or resume of the primary investigator or end user. uir[hQ3~v[[ USMO;N#NvN~0Signature acknowledging your attached laboratory description: [@bD[[cv~{W[nx0 Biosafety or Environmental Officer: uir[hQ#N _____________ ___ ___(KbQ~{W[ v^RvUSMOlQz)_____ Print First and Last Name Y T Signature and stamp~{W[vz  Shipping Address (complete street address) 6e'0W@W Department Bldg. No.|iS Room No.?bS Street Address0W@W CityW^ State/ProvincewN Zip/Postal Code CountryV[ Telephone5u݋ Fax Ow E-mail {  Researcher/End User Information O(uNOo`Complete First & Last NameY TTelephone 5u݋Fax OwE-mail { Only the New Account application is approved can the orders be processed. Your order needs prepayment after confirmed. S g(W^7b3uybQT `vUSMbc6e USnxT`N'>k0 We can accept bNSNcSN NN>ke_ the check l^/ehy Telegraphic Transfer 5uGl'>k _7bL: -NV^LSNRLVRtY L^S: 110010- 285000- 56034676 lQS Ty: SN-NSTZ~8 gPlQS lQS0W@WSN^g3:SNeN11S  100125 If you have questions regarding the status of your application, contact us by phone at 0086-10-62355630 or by e-mail at office@sinozhongyuan.com Yg``wS^7b[ybvۏU\ 5u0086-10-62355630bSN  HYPERLINK "mailto:office@sinozhongyuan.com" office@sinozhongyuan.com DN30uir[hQ[[D(fThe biosafety certificate of laboratory bUSMOvMRl gS_?e^Svuir[hQ[[D(f [bUSMOvuir[hQ{t6R^S[[`QfY N bUSMOb[ۏSuirPgevO(u0PX[0O{0[sSuir[hQZP0R gHec6R0 [[uir[hQ{t6R^bĉ[Sb[[Pgev[hQPX[0O{T[sv{t6R^0[d\ONXTv[hQ{t6R^0[[sXSNhVv[hQO(u{t6R^I{ 0uir[hQ[[Y`Qf(uNYtuirPgev[[Y0NhV Ty 0[TuirPge^irvYtAm z0     ATCC DISTRIBUTOR Beijing Zhongyuan Ltd.  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