PEPTIDE SYNTHESIS ORDER FORM
PEPTIDE SYNTHESIS ORDER FORM
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SHIPPING INFORMATION |
BILLING INFORMATION |
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Name: ___________________________ Address: _________________________ _________________________________ _________________________________ Phone: _______________ Fax: _________________ Email: ___________________________
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Name: ___________________________ Address: _________________________ _________________________________ _________________________________ Phone: __________________ Fax: ____________________ P.O. #: __________________ |
STRUCTURE OF PEPTIDE (N -> C; INDICATE DISULFIDE BONDS):
| Chemistry Desired: ______FMOC _____TBOC C-Terminus: ______AMIDE _____COOH N-Terminus: ______NH3+ ______ACETYL ______SUCCINYL ______OTHER (e.g., benzoyl, aminobenzoyl, etc.) Sequence Requested: _____________________________________________________________ Desired Quantity: _____mgs; _____g; _____ µmol Desired Purity: _____CRUDE (70-85%) _____ >95% _____>98% Mass Spec. Required: _____ Yes _____No Other Information/Requirements: ________________________________________________________________________ ________________________________________________________________________ |