• About Amgen
  • Science
  • Corporate Giving
  • Site Map
  • Search
  • Privacy & Terms
  • Contact Us
Amgen
  • Patients
  • Medical Professionals
  • Partners
  • Investors
  • Careers
  • Media
  • print
  • mail
  • Home
  • Partners
  • Extramural Research
  • Requests for refill

  • Overview
  • Licensing
  • Extramural Research
  • Amgen Ventures
  • Suppliers
Principal Investigator
Title*
First Name*
Middle
Last Name*
Job Title* Degree
Organization*
Addr Line 1*
Addr Line 2
Addr Line 3
Addr Line 4
City* State/ Prov*
Country* Postal Code*
Phone* Fax
E-mail*

Shipping Address (if different from above)
Note: We are unable to ship to P.O. boxes. Investigators in Australia and New Zealand click here.
Addr Line 1
Addr Line 2
Addr Line 3
Addr Line 4
City State/ Prov
Country Postal Code

Courier Service
Name
Acct. No.

Secondary Investigator, if applicable
Title
First Name
Middle
Last Name
Title Degree
Organization
Addr Line 1
Addr Line 2
Addr Line 3
Addr Line 4
City State/ Prov
Country Postal Code
Phone Fax
E-mail

Material Requested
Material Transfer Agreement #*
Material* Quantity*
Material Quantity
Material Quantity
Material Quantity
Material Quantity
Material Quantity

Amgen Contact
Name of Contact

Research Interest
Research update/results/conclusions* (Please limit your text to 4000 characters)
Lab Notebook Reference (your internal reference number)*

footer