Service Request Form

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					                IHCtech, LLC
                12635 Montview Blvd. Ste. 215
                Aurora, CO 80045
                Phone: 720-859-4060
                Fax: 720-859-4110
                pruegg@ihctech.net or jtafoya@ihctech.net
                or nmitchell@ihctech.net www.ihctech.net

                              Service Request Form
Date Shipped: __________
Date Received: _________
Needed complete by: ____________
Date confirmation sent for receiving samples: ____________

Investigators Name: _________________________
Address: __________________________________
          __________________________________
          __________________________________
Phone: ___________________________
E-mail:___________________________
Project Number and description: ______________________________________
Sample accession numbers (include a spread sheet listing the samples and a simple
number for the slides if more than 10 samples are shipped, ie 100.A1, 101.A2, etc.)
__________________________________________________________________
Animal species and tissue type: ________________________________________
Fixation type and length, very important:_________________________________
Samples are in what now? _____________________________________________
Requested Service
Frozen Sections: ___________________________________________________
Paraffin Processing: _________________H&E Stain ______________________
Trichrome Stain: ___________________ AFB Stain ______________________
Other Special Stain and and/or special instructions such as embedding orientation:
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
___________________________________________________________________
attach pictures or diagrams or additional info describing how you want your samples
processed or handled and stained.

Antibody for hrp or IF IHC:______________________________________________

When requesting services from IHCtech, please fill out this form and email
pruegg@ihctech.net or jtafoya@ihctech.net it to us at the time of or before shipping the
samples to us, so that we can track what is shipped to us. A receipt of samples
confirmation will be emailed back to you when we receive the samples.