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

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

Investigators Name: _________________________
Address: __________________________________
Phone: ___________________________
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 or 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.