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To	Japan Health Sciences Foundation Health Science Research Resources Bank

1. I hereby request the distribution of DNA clones below.

Date of application:		Date of receipt:		No.:
Name and title of applicant: Name and address of institution: City: ZIP: Country: Tel.: FAX: E-mail: Name of responsible person: Level of physical containment of facilities: Your purchase/order # (if there is ): FedEx Account # (if you will pay transportation charge directly to FedEx ):
Bill to ( if not the same as applicant ): City: ZIP: Tel.: FAX: E-mail: Proforma/Invoice should be FAXed to: applicantpayer (Name):
-	Registration No.	Name of DNA clone			Amount
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Research purposes:



2. I agree to comply with the following stipulations when I receive the distribution service of DNA clones from the Health Science Research Resources Bank (henceforth abbreviated as HSRRB).
1. I fully respect the priority of the person who established the DNA clone and comply with any limitations proposed on its use.
2. I will not use the DNA clones in unethical experiments such as direct administration to humans.
3. I will use the DNA materials only for research, testing, and educational purposes, and not for military and direct profit-making purposes.
4. I will not impart the DNA materials to a third party.
5. I will not ask HSRRB to be responsible for any accident or loss incurred from the use of the DNA clones.
6. When I publish any results obtained from the use of the DNA clones, I will state the registered number, name, and the establisher (or reference) of the clone along with the name of this bank as the source.