Life Technologies custom
DNA fax order form
USA orders:
Fax: 800 331 2286
Phone: 800 955 6288, ext 46116
Internet: www.lifetechnologies.com
Email: [email protected]
Ship-to information
Bill-to information
Customer number:____________________________________
Purchase order number:___________________________________
Institution:___________________________________________
Institution:_______________________________________________
Shipping address:____________________________________
Bill-to address:___________________________________________
____________________________________________________
City, state, ZIP:___________________________________________
City, state, ZIP:______________________________________
Charge to: _____ Visa ______MasterCard _____Am Ex
Attention:___________________________________________
Credit card number:_______________________________________
Telephone:__________________________________________
Expiration date: Signature:_________________________________
Fax number:_________________________________________
Name of card holder:______________________________________
End-user email address:_______________________________
Quote number (if applicable):__________________________
Contract/release number (if
Additional order information
applicable):______________________________________________
Order placed by:______________________________________
Telephone:__________________________________________
Special handling details (Note: Quote must specify special handling. Contact your Account Manager.)
________________________________________________________________________________________
________________________________________________________________________________________
Instructions
Please use the following codes when identifying nonstandard or mixed
Please provide purchase order number and complete ship-to
bases.
information, including telephone or fax number, to ensure proper
E = g-phosphorothioate
B=T+c+g
R=A+g
F = A-phosphorothioate
D=A+T+g
S=c+g
O = c-phosphorothioate
H=A+T+c
V=A+c+g
Z = T-phosphorothioate
K=T+g
W=A+T
I = deoxyinosine
M=A+c
Y=c+T
U = deoxyuracil
N=A+c+T+g
processing. To avoid confusion, please enter the sequence from
5´ to 3´, clearly differentiating the bases by using uppercase T
and A, and lowercase g and c.
DNA primer 1
Format: ________Tubes (Cat. no. 10336022)
_________Plate (minimum of 48) (Cat. no. 10366014)
Primer name: ________________________________________________________________
Researcher name:____________________________________________________________
Sequence 5´ to 3´: (total # of bases )______________________
__ __ __
__ __ __
__ __ __
__
__ __
__ __ __
__ __ __
__ __ __
1
4
7
10
11 12
13 14 15
16 17 18
19 20 21
2
3
5
6
8
9
__ __ __
__ __ __
__ __ __
__ __ __
__ __ __
__ __ __
__ __ __
22 23 24
25 26 27
28 29 30
31 32 33
34 35 36
37 38 39
40 41 42
__ __ __
__ __ __
__ __ __
__ __ __
__ __ __
__ __ __
__ __ __
43 44 45
46 47 48
49 50 51
52 53 54
55 56 57
58 59 60
61 62 63
__ __ __
__ __ __
__ __ __
__ __ __
__ __ __
__ __ __
__ __ __
64 65 66
67 68 69
70 71 72
73 74 75
76 77 78
79 80 81
82 83 84
__ __ __
__ __ __
__ __ __
__ __ __
__ __ __
___
85 86 87
88 89 90
91 92 93
94 95 96
97 98 99
100
Starting scale: _____ 25 nmol _____ 50 nmol _____ 200 nmol _____ 1 μmol _____ 10 μmol
Purity: _____ Desalted _____ Cartridge _____ HPLC _____ PAGE
Modifications:____________________________________________________________________________
DNA primer 2
Format: ________Tubes (Cat. no. 10336022)
_________Plate (minimum of 48) (Cat. no. 10366014)
Primer name: ________________________________________________________________
Researcher name:____________________________________________________________
Sequence 5´ to 3´: (total # of bases )______________________
__ __ __
__ __ __
__ __ __
__
__ __
__ __ __
__ __ __
__ __ __
1
4
7
10
11 12
13 14 15
16 17 18
19 20 21
2
3
5
6
8
9
__ __ __
__ __ __
__ __ __
__ __ __
__ __ __
__ __ __
__ __ __
22 23 24
25 26 27
28 29 30
31 32 33
34 35 36
37 38 39
40 41 42
__ __ __
__ __ __
__ __ __
__ __ __
__ __ __
__ __ __
__ __ __
43 44 45
46 47 48
49 50 51
52 53 54
55 56 57
58 59 60
61 62 63
__ __ __
__ __ __
__ __ __
__ __ __
__ __ __
__ __ __
__ __ __
64 65 66
67 68 69
70 71 72
73 74 75
76 77 78
79 80 81
82 83 84
__ __ __
__ __ __
__ __ __
__ __ __
__ __ __
___
85 86 87
88 89 90
91 92 93
94 95 96
97 98 99
100
Starting scale: _____ 25 nmol _____ 50 nmol _____ 200 nmol _____ 1 μmol _____ 10 μmol
Purity: _____ Desalted _____ Cartridge _____ HPLC _____ PAGE
Modifications:____________________________________________________________________________
DNA primer 3
Format: ________Tubes (Cat. no. 10336022)
_________Plate (minimum of 48) (Cat. no. 10366014)
Primer name: ________________________________________________________________
Researcher name:____________________________________________________________
Sequence 5´ to 3´: (total # of bases )______________________
__ __ __
__ __ __
__ __ __
__
__ __
__ __ __
__ __ __
__ __ __
1
4
7
10
11 12
13 14 15
16 17 18
19 20 21
2
3
5
6
8
9
__ __ __
__ __ __
__ __ __
__ __ __
__ __ __
__ __ __
__ __ __
22 23 24
25 26 27
28 29 30
31 32 33
34 35 36
37 38 39
40 41 42
__ __ __
__ __ __
__ __ __
__ __ __
__ __ __
__ __ __
__ __ __
43 44 45
46 47 48
49 50 51
52 53 54
55 56 57
58 59 60
61 62 63
__ __ __
__ __ __
__ __ __
__ __ __
__ __ __
__ __ __
__ __ __
64 65 66
67 68 69
70 71 72
73 74 75
76 77 78
79 80 81
82 83 84
__ __ __
__ __ __
__ __ __
__ __ __
__ __ __
___
85 86 87
88 89 90
91 92 93
94 95 96
97 98 99
100
Starting scale: _____ 25 nmol _____ 50 nmol _____ 200 nmol _____ 1 μmol _____ 10 μmol
Purity: _____ Desalted _____ Cartridge _____ HPLC _____ PAGE
Modifications:____________________________________________________________________________
DNA primer ____
Format: ________Tubes (Cat. no. 10336022)
_________Plate (minimum of 48) (Cat. no. 10366014)
Primer name: ________________________________________________________________
Researcher name:____________________________________________________________
Sequence 5´ to 3´: (total # of bases )______________________
__ __ __
__ __ __
__ __ __
__
__ __
__ __ __
__ __ __
__ __ __
1
4
7
10
11 12
13 14 15
16 17 18
19 20 21
2
3
5
6
8
9
__ __ __
__ __ __
__ __ __
__ __ __
__ __ __
__ __ __
__ __ __
22 23 24
25 26 27
28 29 30
31 32 33
34 35 36
37 38 39
40 41 42
__ __ __
__ __ __
__ __ __
__ __ __
__ __ __
__ __ __
__ __ __
43 44 45
46 47 48
49 50 51
52 53 54
55 56 57
58 59 60
61 62 63
__ __ __
__ __ __
__ __ __
__ __ __
__ __ __
__ __ __
__ __ __
64 65 66
67 68 69
70 71 72
73 74 75
76 77 78
79 80 81
82 83 84
__ __ __
__ __ __
__ __ __
__ __ __
__ __ __
___
85 86 87
88 89 90
91 92 93
94 95 96
97 98 99
100
Starting scale: _____ 25 nmol _____ 50 nmol _____ 200 nmol _____ 1 μmol _____ 10 μmol
Purity: _____ Desalted _____ Cartridge _____ HPLC _____ PAGE
Modifications:____________________________________________________________________________