Form: PIMS-SOF
PROTEIN IDENTIFICATION
BY MASS SPECTROMETRY
CUSTOMER INFORMATION
Dr.
Mr.
SERVICE ORDER FORM
KINEXUS ORDER NUMBER
For Kinexus internal use only.
Subject to terms of the Kinexus Proteomics Services Agreement
REPEAT CUSTOMER
OR
NEW CUSTOMER
Ms.
Name of Authorized Representative or Principal Investigator
Title/Position
Company Name or Institute
Department
Street Address
City
State or Province
Email Address
(Area Code)
Contact Person (if different from Authorized Representative)
Email Address
Country
Zip or Postal Code
Telephone Number
(Area Code)
Facsimile Number
(Area Code)
Telephone Number
STUDY REPORTS
RESULTS SENT BY EMAIL TO:
AUTHORIZED REPRESENTATIVE/INVESTIGATOR AND/OR
CONTACT PERSON
PRICING INFORMATION
Services offered for identification of antibody cross-reactive proteins by immunoprecipitation and mass spectrometry.
PRICING - Refer to Section D of the Sample Identification Forms:
All prices in U.S. Funds
THE PROTEIN IDENTIFICATION IS CARRIED OUT IN TWO STAGES: 1ST STAGE BY IMMUNOPRECIPITATION OR
IMMUNOAFFINITY, 2ND STAGE BY MASS SPECTROMETRY.
Follow on order - One antibody chosen for immunoprecipitation stage of study x US$600 per antibody =
Follow on order – Two or more antibodies chosen for immunoprecipitation stage of study x US$500 per antibody =
New order - One antibody chosen for immunoprecipitation stage of study x US$750 per antibody =
New order - Two or more antibodies chosen for immunoprecipitation stage of study x US$625 per antibody =
$
$
$
$
Follow on order – Non-confidential – Number of protein bands for MS identification analysis x US$600 per band =
Follow on order – Confidential – Number of protein bands for MS identification analysis x US$800 per band =
New order – Non-confidential – Number of protein bands for MS identification analysis x US$720 per band =
New order - Confidential – Number of protein bands for MS identification analysis x US$960 per band =
$
$
$
$
Estimated cost of this order (Final price will dependent on number of protein bands actually submitted
for mass spectrometry analysis after client approval)
Subtotal
=
$
-$
PROMOTIONAL DISCOUNT IF APPLICABLE (PROVIDE QUOTATION OR REFERENCE NUMBER)
Subtotal
FOR CANADIAN CUSTOMERS ONLY: Add an additional 12% to the above total for HST (No. 893907329 RT0001):
TOTAL COST FOR THIS ORDER
=
$
+$
TOTAL = $
TOTAL AMOUNT PAYABLE IN U.S FUNDS
PAYMENT METHOD
PURCHASE ORDER
VISA
ACCEPTED FROM COMPANIES AND INSTITUTES WITH APPROVED CREDIT.
MASTERCARD
OR
Print Cardholder Name
BILLING INFORMATION
Dr
Mr
P.O. NUMBER:
Visa Number
Expires (M/Y)
SEND INVOICE TO CUSTOMER AT ABOVE ADDRESS OR
Cardholder Signature
SEND INVOICE TO ACCOUNTS PAYABLE CONTACT:
Ms
Accounts Payable Contact Name
Company Name or Institute
Street Address
City
State or Province
Country
Zip or Postal Code
(Area Code) Telephone Number
AUTHORIZATION
CUSTOMER HAS READ THE KINEXUS PROTEOMICS SERVICES AGREEMENT AND AGREES TO BE BOUND BY THE TERMS AND CONDITIONS:
Print Name of Authorized Representative or Principal Investigator
How did you originally hear about the PIMS services?
Authorized Signature
Direct Mail
Email
Web Site
Advertisement
Date (Y/M/D)
Referral
Conference or Trade Show
Other