Human+Mouse Human Mouse Rat

Fax or email this order form to:

Fax : +32(0)2 791 57 97

Email :

www.labomics.com

Please complete the following fields and submit a fax (+32(0)2 791 57 97) or an email () to LabOmics. You will receive an order confirmation within 48 hours of submission.

1.  Select Species (compulsory) :

¦ Human+Mouse ¦ Human ¦ Mouse ¦ Rat

2.  Specify your gene of interest. Give us as much information as you can. We recommend to use the latest gene’s RefSeq number from NCBI (http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=gene) :

Symbols/Aliases:
Gene Description :
Nucleotide Accession :
Entrez Gene ID:
UniGene ID :
Catalog/Product ID :

Alternatively, you can provide your own sequence, please enter query sequence here. We will perform BLAST analysis for homology search for you :

Note: the price for one clone starts at 640 €

3.  Related products : (optional)

For negative controls : specific miRNA Target control vector:

¦ / Specific miRNA Target clone control vector *250 €

*starting price if purchased together with miRNA target clone of same product ID

If you need additional information, our technical staff can help you determine the best approach for your experimental goals. Send us an email at and we will contact you shortly.

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4.  Your details :

Customer Purchase Order # : / Order Date :
_ _ / _ _ / _ _ _ _

Delivery Address Invoice Address (If Different)

Name/
Contact / Name/
Contact
Company/
Institution / Company/ Institution
Address / Address
Dept / Dept
Lab / Lab
City/Zip / City/Zip
Country / Country
Phone / Phone
Fax / Fax
Email / Email
VAT Number of your institution/company :

NB: Please refer to our conditions of sale. All orders are subject to Shipping Cost. Please inquire.

Authorized Signature :

Special Instructions :

LabOmics S.A. - www.labomics.com – Fax: +32(0)2 791 57 97 page 1/2