FISH Service Order Form

1. Probe information
Probe name:
Species: human    mouse    rat   
others:  
Type of probe: cDNA genomic DNA
(Please attach a gel picture, indicating sizes of insert,vector and corresponding marker with volumes loaded.)
Vector name:
Insert size: kb
Insertion site: (eg: EcoRI/XbaI)
DNA concentration:  ug/ul     (approximately 1.0ug/ul)
2. Requisition
Mapping on human chromosome,      mouse chromosome,     specific cell line,
                      Tg mouse chromosome, Specific request:
Catalog number:   
3. Customer information
Contact: 
Principle Investigator:  
Tel (important):
E-mail:    
E-mail:    
Fax:    
Shipping address (including department/institute/company):

4. Billing Information:
Contact:
Department:
P. O. #:
Tel:
Fax:
E-mail:
Billing address (if different from shipping address):

5. Additional photo:  sets      Presentation slide:  sets
    Rush service:     Yes    No
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:
7. Please read the terms of "Service Agreement" before you sign this order form.

    Your signature:__________________________     Date: _______________
PLEASE CONTACT US TO CONFIRM YOUR SCHEDULE DATE BEFORE SHIPMENT DATE
Please send the completed form with your samples to:
Customer Service, SeeDNA Biotech Inc., 443 Ouellette Avenue, Suite 100,  Windsor, Ontario, Canada N9A 4J2
Tel: (519) 252-8669 , Fax: (519) 252-2915, E-mail:    URL: http://www.seedna.com
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