CoreRx Request For Proposal (RFP) Form

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> RFP Request

Associations CoreRx Belongs To

Please help us to better serve your needs by completing this brief questionnaire regarding your proposed project.

Contacted By/Heard About Us From:
Name:
Title:
Company:
Address 1:
Address 2:
City:
State:
Zip Code:
Phone:
Email:
Short Project Description:
Project Time Frame:

Special Handling Required:	Controlled Substance; Class Potent Compound; Class Light/Heat/Moisture Sensitive Other
	If Other:

Pre-formulation
Describe Required Testing:

Analytical
Brief Description of Testing:

Will test methods be provided?	Yes No
	Drug Substance: Assay Related Substances Drug Product: Assay Related Substances Dissolution

Test Methods Required	Assay Related Substances Dissolution Other If other:

	ID; by If other:

Method Validation Required	Assay Related Substances Dissolution Other If other:


Formulation Development
Brief Description of Needs:

Phase of Project:	Tox Phase I Phase II Phase III Other If other:
Excipient Compatibility:	How many excipients?
Prototype Stability:	Storage Temperature: 5°C 25°C 30°C 40°C other °C	Storage Humidity: 60%RH 65%RH 70%RH 75%RH other %RH

Manufacturing Services
Brief Description of Needs:
	cGMP non-cGMP
Dosage Form Desired:	Parenteral: Liquid Lyophilized Suspension Oral: Oral Liquid Semi-Solids: Cream Gel Ointment Lotion Other: If other:	Solids: Tablet Capsule Liquid Capsule Lozenge API in capsule API In Bottle Overencapsulation Suppository Opthalmic: Liquid Suspension Ointment
Dosage Strength(s) Desired:
Approximate Batch Size: