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order information of adenovirus to be completed by investigator

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					AGTC Gene Technology Company . ORDER INFORMATION OF ADENOVIRUS
TEL£º FAX£º (86)10-67866659 (86)10-67871177 (86)10-67877776 service@agtc.com.cn

E-MAIL£º URL£º

www.agtconline.com

TO BE COMPLETED BY INVESTIGATOR Name Company/Institute Shipping Address Accounts Payable Address Contact Person E-mail /Phone/Fax

THE INFORMATION OF YOUR VIRAL SEED Type of Virus Virus Name Is expressed protein of gene toxic to cells? Is expressed protein of gene harmful to human and environ ment Purpose of project A. Yes B. No C. Unclear A. No B. Yes, detail specification A. B. C. D. E. basic research apply for test to FDA(or Sino-FDA) pharmacological and pharmacodynamical trial clinical trial others B. Ad-Max times C. others A. Ad5 B. Ad5F35 C. Other

System of preparation

virus

A. Ad-easy A. Yes. B. No.

Has the virus been plaque screened Passage of virus

Passage£º Conditions of conservation£º Date of frozen: IU/ml (TCID50) or Date of assay: pfu/ml(plaque assay)

Titer of virus

Have the viral seed been screened?

A. mycoplasma B. sterility C. AAV D. HIV E. HCV F. HBV G. RCA

Yes¡õ Yes¡õ Yes¡õ Yes¡õ Yes¡õ Yes¡õ Yes¡õ

No¡õ No¡õ No¡õ No¡õ No¡õ No¡õ No¡õ

H. which are satisfied by FDA(or Sino-FDA) above Note: Please fill in the attached file if you did the above assay The yield of the viral seed per cell v.p./cell

Have viral seed banks been made for GMP manufacturing? Master seed bank Working seed bank Yes¡õ Yes¡õ No¡õ No¡õ

Have the viral seed banks been screened? mycoplasma sterility AAV HIV HCV HBV RCA Virus characteristics you require Manufacturing grade
¡õ GMP ¡õ non-GMP

Yes¡õ Yes¡õ Yes¡õ Yes¡õ Yes¡õ Yes¡õ Yes¡õ

No¡õ No¡õ No¡õ No¡õ No¡õ No¡õ No¡õ

Total quantity you require Plaque screening Other specifications you require

v.p., IU(TCID50 assay) (>1 IU/33 particles at average) A. Yes. B. No 1 time¡õ 2times¡õ 3times¡õ

Attached file TESTING LIST FOR ADENOVIRAL SEED Please fill in the details. AGTC will test again according to the methods you offer. characteristic PCR
(please supply primers)

Date of assay

methods
(Including template treatment, PCR reaction components and program )

results
(electrophoresis pattern)

mycoplasma

sterility

AAV

HIV

HCV

HBV

RCA


				
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Description: order information of adenovirus to be completed by investigator