Meat & Poultry Inspection

REQUESTER INFORMATION
Name			Title:
Organization:			Date:
Phone:			Fax:
Address:
ESTABLISHMENT INFORMATION (Permission from the establishment management must be obtained prior to submitting this form.)
Plant Name:			City:
Kind and Amount of Material Desired: (include species of animal)
Indicate Purpose of Collecting Specimens:
Education			Research
Pharmaceutical			Experimental
Other (specify)
Describe Purpose of Collecting Specimens:

Telephone Numbers for Speech and Hearing Impaired
TTY: 1-800-735-2962 Voice: 1-877-735-8200

NCDA&CS - Meat and Poultry Inspection Division, Donald H. Delozier , Director
Mailing Address:1001 Mail Service Center Raleigh, NC 27699-1001
Physical Address: 2 West Edenton Street , Raleigh, NC 27601
Phone: (919) 733-4136; FAX: (919) 715-0246; TA Office: (919) 733-0167