This form may be printed and completed by hand, or completed online and printed. Submit with your samples.
Note: This form is for DNA Sequencing only. Please see Fragment Analysis form for Fragment Analysis submission.
PNACL 11/17/2015
Nucleic Acid Chemistry Laboratory
DNA SEQUENCING
User _______________________ P.I. _________________________
Phone
Date ______________
FOR OUTSIDE USERS, A
PO# IS REQUIRED WITH
SAMPLE SUBMISSION:
_____________________ Fax ________________________
Email _______________________ Dept. ________________________
________________________
I acknowledge these samples are for research purposes only, not for diagnostic use. Initials _______
SEQUENCING CHEMISTRY (Please select one of the following):
ABI Big Dye V1.1 ____
ABI Big Dye V3.1____
SAMPLE DATA (If more than 15 samples, please attach completed Additional Samples form):
PCR reaction needed?
No _____
Yes _____
________Please initial that you have verified the primer sequence.
Clean up needed?
No _____
Yes _____
Printout(s) needed? No _____
Yes @ PNACL _____
Sample Name
Sample Name
PNACL #
Yes @ CSRB _____
PNACL #
Sample Name
1.
6.
11.
2.
7.
12.
3.
8.
13.
4.
9.
14.
5.
10.
15.
PNACL #
Note: Due to administrative costs beyond our control,
all bills that are paid by check will include an additional 20% surcharge
Contact: Misty Veschak, 314-362-0282
[email protected]
Billing Questions: Kati Riebold, 314-747-5523
[email protected]
http://devbio.wustl.edu/pnacl/pnacl.home.html
For Office Use Only
Individual Samples:
______ Reaction and Sequencing (provided in Tubes)
______ Ready to Run Samples (provided in Tubes)
______ dGTP Reaction and Sequencing (provided in Tubes)
96Well Plates: Please use template provided (link will go here)
______ 48-72 wells (per well Reaction and Sequencing)
______ 73-96 wells (per plate Reaction and Sequencing)
______ Ready to Run Plates (per well, minimum 48 wells)
______ dGTP Reaction Plate (minimum 70 wells)
Other:
______ Dye Terminator removal/clean up
______ Data Printouts
______ Consultation for Academic Labs
______ Consultation for non-Academic Labs
Academic Pricing
$ 5.00
$ 2.50
$ 9.00
$ 4.00
$ 288.00
$ 2.25
$ 600.00
$ 1.00
$ 1.25 ea.
Free
$ 75.00 / hr.
Nucleic Acid Chemistry Laboratory
DNA SEQUENCING
ADDITIONAL SAMPLES
User __________________________
Sample Name
PNACL #
Phone ______________________
Sample Name
PNACL #
31.
46.
17.
32.
47.
18.
33.
48.
19.
34.
49.
20.
35.
50.
21.
36.
51.
22.
37.
52.
23.
38.
53.
24.
39.
54.
25.
40.
55.
26.
41.
56.
27.
42.
57.
28.
43.
58.
29.
44.
59.
30.
45.
60.
Fax: 314-362-4698
Date ________________
Sample Name
16.
Office phone: 314-362-0282
PNACL 11/17/2015
PNACL #
http://devbio.wustl.edu/pnacl/pnacl.home.html