Email and Fax Order Template
Total Page：16
File Type：pdf, Size：1020Kb
Custom DNA Oligos Fax Order Form
Please complete this form and fax it back to Eurofins Genomics: UK: +44-1902-693-286; France: +33-1-69-10-88-84; Rest Europe & ROW: +49-8092-21084 Note: Max. 10 oligos per fax order. Please do not email this form. Application oligos can only be ordered online.
Contact Details
Your Delivery Address: Your Invoice Address: First & Last Name: Institute / Department: University/Company.: Street: Postal Code / City: Country: Phone / Fax: Email: Customer ID:
Order Ref. No.: Quote-No.: Delivery Service: Express Standard (for Germany only) VAT Exempt (UK only): Yes* No VAT-No. (EU only): * Please provide VAT exemption certificate
Oligo Order
No. Oligo Name: Synthesis 0.01 0.05 0.20 1.00 10.0 (max.15 characters) Scale [µmol]:
Modification Purification Level Quality Documentation 5’: 3’: Intern: Salt Free HPSF HPLC HYPUR Yes No
5’ 3’
No. Oligo Name: Synthesis 0.01 0.05 0.20 1.00 10.0 (max.15 characters) Scale [µmol]:
Modification Purification Level Quality Documentation 5’: 3’: Intern: Salt Free HPSF HPLC HYPUR Yes No
5’ 3’
No. Oligo Name: Synthesis 0.01 0.05 0.20 1.00 10.0 (max.15 characters) Scale [µmol]:
Modification Purification Level Quality Documentation 5’: 3’: Intern: Salt Free HPSF HPLC HYPUR Yes No
5’ 3’
No. Oligo Name: Synthesis 0.01 0.05 0.20 1.00 10.0 (max.15 characters) Scale [µmol]:
2014-03-14 1 Custom DNA Oligos Fax Order Form
Modification Purification Level Quality Documentation 5’: 3’: Intern: Salt Free HPSF HPLC HYPUR Yes No
5’ 3’
No. Oligo Name: Synthesis 0.01 0.05 0.20 1.00 10.0 (max.15 characters) Scale [µmol]:
Modification Purification Level Quality Documentation 5’: 3’: Intern: Salt Free HPSF HPLC HYPUR Yes No
5’ 3’
No. Oligo Name: Synthesis 0.01 0.05 0.20 1.00 10.0 (max.15 characters) Scale [µmol]:
Modification Purification Level Quality Documentation 5’: 3’: Intern: Salt Free HPSF HPLC HYPUR Yes No
5’ 3’
No. Oligo Name: Synthesis 0.01 0.05 0.20 1.00 10.0 (max.15 characters) Scale [µmol]:
Modification Purification Level Quality Documentation 5’: 3’: Intern: Salt Free HPSF HPLC HYPUR Yes No
5’ 3’
No. Oligo Name: Synthesis 0.01 0.05 0.20 1.00 10.0 (max.15 characters) Scale [µmol]:
Modification Purification Level Quality Documentation 5’: 3’: Intern: Salt Free HPSF HPLC HYPUR Yes No
5’ 3’
With this order I accept the General Terms and Conditions of Sale (GTCs from 01.04.201) of Eurofins Genomics GmbH.
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