Application form – RCS Research – Research Chemical Supply

Existing Customer

New Customer

You have to fill out our application, prior to using the website.

THIS IS ONLY FOR NEW CUSTOMERS

In an effort to ensure the proper use of our products new customers must fill out the application below. Please note that answering N/A will result in an automatic denial.

Step 1

Researcher's Information

Name

First

Last

Address

City

State

Zip code

Phone

Qualifications

Professional Experience & Background

Educational Background

Please describe in detail your research protocol clearly indicating:

A. The specific aims and goals of proposed study

B. The number of experiments and experimental subjects

C. What chemicals and dosages are you planning to use?

D. What type of subject you will be administering to? (Human Trials will be denied unless within 24 hours of your application you submit your Investigational New Drug (IND) number and a copy of approved IND letter from the FDA. A copy of your Institutional Review Board (IRB) approval letter , A copy of your Data Safety and Monitoring Plan, Proof of registration with clinicaltrials.gov (NCT #) and a copy of the study consent form(s) to compliance@RCS-research.is | Failure to provide the requested documents for human subjects will result in an automatic denial.)

Human Trials will be denied unless within 24 hours of your application you submit your Investigational New Drug (IND) number and a copy of approved IND letter from the FDA. A copy of your Institutional Review Board (IRB) approval letter , A copy of your Data Safety and Monitoring Plan, Proof of registration with clinicaltrials.gov (NCT #) and a copy of the study consent form(s) to compliance@RCS-research.is | Failure to provide the requested documents for human subjects will result in an automatic denial.)

Upload your ID

RCS strictly adheres to the law ensuring real people are purchasing our products for proper use. As part of our "know your customer policy" your ID is required. You are welcome to blur out your ID/License number and birthdate if that makes you feel comfortable with the upload.

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