【Sample of Form M-10/M-10C】・Obtain the latest version of the form file from the(Form M-10-1)
JCM website to prepare the document.

・Use Adobe Acrobat or Reader to prepare theJAPAN COLLECTION
OF MICROORGANISMS

RIKEN BRC

document (do not use third-party PDF editing tools).

ORDER FORM (payment by bank transfer)

Date

the RECIPIENT,
fill in the same person as theTo: JapanAs
Collectionof Microorganisms"Scientist (Principal Investigator)" described in
RIKEN BioResource Research Center

Order date

the MTA (Form M-11/M-11C).

RECIPIENT / SHIP TO: (MTA Contractor Only)
Name:
Department / Division:
Organization:
Organization type (please check one):
Address:❑ For-Profit❑ Not-for-Profit
Zip code:Country:

Fill in official address in detail as onyour website etc.

Recipient Website:
Recipient E-mail:Fill in your EORI number if yourorganization is in the EU member states.

Fill in if contact person isdifferent from “Recipient”.

Contact person E-mail:
TEL:
Carrier: ❑ FedEx Account No. (❑ Post (Registered mail)Fill in official name and address ofRecipient Organization (includingdepartment) without using abbreviation.

Job Title:

EORI No.:
FAX:

Fill in your account holder information
if you use FedEx or TNT as your carrier.

)❑ TNT Express Account No. (FedEx/TNT Account Holder Name ())

AUTHORIZED REPRESENTATIVE (President, Dean, Director or Intellectual Property Administrator)
Name:
Department / Division:
Organization:

Job Title:“Authorized Representative” should be a person authorized
to sign on behalf of the organization.
・Dean of University / College / School / Faculty
・President of Company
・Head of Intellectual Property Management Division

Website :BILLING ADDRESS (If Billing Address is the same as RECIPIENT, leave it in blank)
Name:
If BILLINGADDRESS is the same
Department/ Division:
as RECIPIERNT, leave it blank.
Organization:
Address:
Zip code:Country:

Fill in “PO Number” and / or “VAT Number / TAX ID Number”
if it is necessary to be written in an invoice.

Your purchase order no.:E-mail:TEL:

VAT-No.:FAX:RESEARCH PURPOSE (Specific of microbial strains purpose of use / method)

Fill in research purpose in detail.
Write specific how and for what purpose you are going to use
information is Column
consideredinsufficient,
weMicrobe Division JCM/ Japanstrain(s).
CollectionIfofthe
Microorganisms
to be filled
by RIKEN BRC
mayResearchask you
to add more or rewrite (Receptionit.
RIKEN BioResource
CenterDate
3-1-1 Koyadai, Tsukuba, Ibaraki 305-0074, Japan
E-mail: inquiry.jcm@riken.jp(Reception No.
(MTA No.

BBM－)))(2023-10-02)

Attach an extra sheet entitled “ Attachment
for Order Form” in case space is not enough.

Check the online catalogue and fill in(Form M-10C-2)
the latest scientific name including
the subspecies name, if any.

ATTACHMENT FOR ORDER FORM
JCM No.

Scientific name

Deliverycategory*Quantity

Biosafetylevel

1217
7050

Bifidobacterium longum subsp. longum
Bifidobacterium longum subsp. longum

AA111138422

Pyrococcus furiosus

B11412257

Porphyromonas gingivalis

C12

12

56
7

"Scientific name"8910111213"JCM No."

1415

Fill in the number specified here (1 or 2) in the"Biosafety level" field.

16If "2 (provisional)" is displayed here, fill in "2".

cc

1718

When "Controlled" is indicated here,
we cannot provide the strain to overseas users.

1920

If "Restricted" is displayed here, it can be exported.
21
22

When "Restricted" is indicated here,
we cannot provide the strain to overseas users.

23
24

Fill in the alphabetic symbol shown here
(A, B, C or F) in the "Delivery category" field.

25
26
27
28
29
30

Confirm Delivery category, Carrier* Please select an appropriate delivery category (A-C, F). The categories
available
for eachof strains
and Feefor eachstrain
hereare shown on the respective
websites of the JCM online catalogue (https://jcm.brc.riken.jp/en/catalogue_e).

Delivery category
A Freeze-dried or L-dried culture

Post

Carrier
Forwarder

Acceptable

Acceptable

Fee (Japanese yen)
For-profit

Not-for-profit¥5,500-¥11,000-F Frozen culture with dry-ice
Unavailable Recommend¥14,960¥7,480Actively growing culture of a microbial strain that cannot be
B
Acceptable Recommend¥22,000¥11,000preserved as a dried culture
C Actively growing culture on request
Acceptable Recommend¥19,030¥38,060Note: Shipping costs will be charged to overseas users. If the forwarder is selected, the shipping company should bearranged for by the Recipient, and the fee for shipping should be handled cash on delivery (COD).
(2023-04-01)