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1. Probe information |
Probe name:
| ____________________________ |
| Species: |
___ human
___ mouse
___ rat
___ others: __________________
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Type of probe: |
___ cDNA
___ genomic DNA
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(Please attach a gel picture, indicating sizes of insert,vector
and corresponding marker with volumes loaded.)
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Vector name: | ____________________ |
| Insert size: |
________ kb |
| Insertion site: |
________ (eg: EcoRI/XbaI) |
| DNA concentration: |
________ ug/ul | |
(approximately 1.0ug/ul) |
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2. Requisition |
Mapping on
___ human chromosome
___ mouse chromosome
___ specific cell line
___ Tg mouse chromosome
___ Specific request:
________________________________
Catalog number:
________
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3. Customer information |
|
Contact name: | ______________________________ | |
E-mail: | ______________________________ |
|
Principle Investigator: |
______________________________ | |
E-mail: | ______________________________ |
|
Tel (important): |
______________________________ | | Fax: |
______________________________ |
Shipping address (including department/institute/company):
________________________________________________________________
________________________________________________________________
________________________________________________________________
|
|
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4. Billing Information
|
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Contact: | ___________________________ |
| Department: | ___________________________ |
| P. O. #: | ___________________________ |
|
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Tel: | ___________________________ |
| Fax: | ___________________________ |
|
E-mail: | ___________________________ |
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Billing address
(if different from shipping address):
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
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5. Additional photo: ____ sets
Presentation slide: ____ sets
Rush service: ____ Yes
____ No
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6. Where did you hear SeeDNA? (Please check all which apply)
___ letter from SeeDNA
___ collaborator or colleague
___ advertisement
___ searching internet
___ from SeeDNA's distributors
___ other:
___________________________________
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7. Please read the terms of "Service Agreement"
before you sign this order form.
Your signature:__________________________
Date: _______________
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