"doc Par 9546 File"
542 Flynn Rd, Camarillo, CA 93012 USA Custom Service Requirements Form BIOLOGICS CUSTOM ASSAY REQUEST FORM Please submit completed form to email@example.com Contact Information: Name: Date: Organization: Department: Shipping Address: Billing Address: Email: Phone Number: Nature of Inquiry: Pricing estimate Feasibility Proposal with Options For Grant Submission Estimated Order Immediately 1-2 Months 2-4 Months >4 Months Other: Initiation: Please fill in the information below to describe your request. CUSTOM ASSAY REQUEST Assay Platform Please choose one of the options from the drop-down menu: If other, please describe: Please indicate the target protein(s) or epitope(s) you are trying to detect: Is there a literature reference for your desired assay? YES NO If yes, please tell us about it: Current Experimental Set-Up Do you have an established system that expresses the target(s) in a robust manner? YES NO If yes, please describe in detail: Do you require protein production or purification services? YES NO Please describe: Which assays are you currently using to detect the target(s)? Sample Information What is your target species? FORM-QA-00058 Rev 0.0 542 Flynn Rd, Camarillo, CA 93012 USA In which sample type(s) do you need to detect the target(s)? If other, please provide details: If plasma, please specify type-EDTA, Citrate, Heparin, etc.: If cell lysate or tissue homogenate, do you require specific extraction buffers/conditions? YES NO If yes, please describe in detail: If there is additional information you can provide about your samples, please indicate: Additional Information How many samples do you expect to screen with this assay? What is your minimum plate/sample requirement? Do you have any antibodies or proteins produced at your facility that could be used in YES NO developing the assay? Will these antibodies or proteins be available for license by Invitrogen if they work in the YES NO assay? Thank you for your inquiry. Please email completed form to firstname.lastname@example.org FORM-QA-00058 Rev 0.0