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Toll Free: (800)758-1630
Fax: (800)507-2912

Cloning, Expression and Stable Cell Line Request Form
Contact Information
PO#: Institution/Company:
Name: Rm/Lab/Suite:
Tel: Street Address:
Email: City, State,Zip:
Gene Cloning and Expression
Gene Name:
Gene cloning for: Protein expression and purification    Transfection     Probe    Other_________________
Primers needed?(extra charge): Yes     No     If "Yes", sequence:_______________________________________
cDNA library needed?(extra charge): Yes No   If "Yes", cDNA library source: ___________________________
Sequencing cloned gene?    Yes       No
Cloned cDNA quantity:   1µg      10µg     100µg     1mg
Cloned cDNA in:   TE     H2O     Other __________________________________________________________
Plasmid from customer: Yes      No      Expression vector name:_____________from company:____________
Plasmid Sequencing:    Yes    No      Results:________________________________________________________
Cloning information: Map available  TA cloning  Restriction enzymes for cloning_______________________
If not cloned, cDNA provided?   Yes    No    If "No", source to amplify the gene:________________________
If not cloned, primers provided?   Yes    No   If "Yes", primer sequence:_______________________________
Expression testing:   Yes     No   Conditions and results: _____________________________________________
Stable Cell Line
Cell line provided?     Yes     No   
                                   If "Yes", cell line name: ______________________________________
                                                    If "No", which cell line you need: ______________________________
Stable cell line testing: Yes     No   If "Yes", conditions and results: __________________________________
Mycloplasma testing: Yes     No  
Endotoxin testing: Yes     No  
Quantity of stable cell line needed (5x106/vial): 2 vial    5 vial     10 vial   Other:_________________
Special Instructions
Signature:________________________                           Date: __________
Please print and complete the above form, fax to (800)507-2912.
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