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CUSTOM PEPTIDE SYNTHESIS REQUEST FORM

Please ensure you complete the form below before designing your sequences. Thankyou.

CONTACT DETAILS
Name(*):   Email Address(*):  
Telephone Number(*):   FAX Number:
Department: Company:
Address: Post/ZIP Code:
Country: Customer Ref. Number:
Interests: Other:
Purchase Time Frame(*):

SERVICE REQUIREMENTS
If you would like us to provide peptide design for your antibody production please let us know the details of your target.
*Protein Accession Number / Genbank Reference: * Leave blank if Unknown
Peptide 1
Peptide Sequence:
Peptide Name: No. of Residues:
Quantity: Purity:
Conjugation: Other:   C-terminal amidation(*):
Modification: Other Modification:
Peptide 2
Peptide Sequence:
Peptide Name: No. of Residues:
Quantity: Purity:
Conjugation: Other: C-terminal amidation(*):
Modification: Other Modification:
Peptide 3
Peptide Sequence:
Peptide Name: No. of Residues:
Quantity: Purity:
Conjugation: Other: C-terminal amidation(*):
Modification: Other Modification:
Peptide 4
Peptide Sequence:
Peptide Name: No. of Residues:
Quantity: Purity:
Conjugation: Other: C-terminal amidation(*):
Modification: Other Modification:
Additonal Comments:

             

INDEX