Sera/Virus Request Form

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Instructions: Please fill out the form below. Make sure in the Sera/Virus request section to request at least one serum or virus. Once the form is complete, you will want to email your permit as a [TBD] to bfq7@cdc.gov. Once you have finished the form, you will be guided to a submission page and given an email reminder to submit your permit. Please be aware the process will not be complete without a permit.

For general assistance and questions, please contact bfq7@cdc.gov.

Required fields are preceded by an asterisk (*).

Shipping Information

*Prefix:

*Title / Rank:

*First Name:

*Last Name:

*E-mail Address:

*Facility Name:

*Facility Phone Number:

*Laboratory Director Name:

*Street Address:

Street Address (continued, optional):

*City:

State: (For international locations, please use the text box below to complete.)

International State (not required for U.S. locations):

*Country:

*Postal Code:

Sera/Virus Request

Instructions: In the section below, please enter which sera or viruses you would like to acquire. You can request multiple entries of either sera or viruses. Please fill out a minimum of at least one serum or virus to request.

Serum
(Please type out the serum. Max of 10 quantity per serum.)

Virus
(Please type out the virus and select a source material for each. Max of 3 quantity per virus.)

Additional Comments: