FAX ORDER FORM
Ship to Address
First Name:
Last Name:
PI First Name:
PI Last Name:
Organization:
Address Line 1:
Address Line 2:
City:
State/Province:
Postal Code:
Country:
Telephone:
Fax:
Credit Card #:
Name on Card:
Expiration Date:
Purchase Order Number:
OligoCard Number:
Quote Number:
Product Information
Available Synthesis Scales:
- 25nm, 100nm, 250nm, 1µm, 5µm, 10µm
Purification Methods:
- PAGE, HPLC, IE-HPLC, and RNase-Free HPLC available on the
100nm scale and higher (Standard Desalt available on all scales)
Modification Codes and Modified Bases can be found at:
http://www.idtdna.com/pages/support/technical-vault/reading-room/quickreference/all-modifications
Email:
Bill to Address
Same as Ship To Address:
Organization:
Address Line 1:
Address Line 2:
City:
State/Province:
Postal Code:
Country:
Telephone:
Fax:
Email:
Sequence Name:
Scale:
Payment Information
Entry Instructions
1. Fill out the shipping, billing, and payment information
2. Enter Sequence Name and desired Scale
3. Enter sequences 5' to 3' in CAPS except "g"
4. "r" preceding a base designates RNA/"m" preceding a base
designates 2' O-Methyl
5. Enter modification codes within the sequence
6. Enter desired Purification Method
7. Enter an “X” in the LabReady box for each oligo
that requires this service
8. Fax order to 1-319-626-8444
Sequence:
___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___
___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___
___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___
___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___
___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___
Sequence Name:
Scale:
Sequence:
___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___
___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___
___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___
___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___
___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___
Purification:
☐LabReady
Purification:
☐ LabReady
Special Instructions: __________________________________________________
___________________________________________________________________
Fax: 1-319-626-8444
Web Site: www.idtdna.com
Phone: 1-800-328-2661
ORE-032 REV 04
Sequence Name:
Scale:
Sequence:
___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___
___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___
___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___
___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___
___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___
Sequence Name:
Purification:
☐ LabReady
Sequence:
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Purification:
Sequence:
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Purification:
Sequence Name:
Sequence:
___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___
___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___
___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___
Purification:
Scale:
___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___
___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___
Sequence Name:
Sequence:
___ ___ ___
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Purification:
Sequence:
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Purification:
Sequence:
___ ___ ___
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___ ___ ___
___ ___ ___
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___ ___ ___
___ ___ ___
___ ___ ___
___ ___ ___
___ ___ ___
___ ___ ___
___ ___ ___
___ ___ ___
___ ___ ___
___ ___ ___
___ ___ ___
___ ___ ___
___ ___ ___
___ ___ ___
___ ___ ___
___ ___ ___
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Purification:
Scale:
Sequence Name:
Scale:
Scale:
Sequence Name:
Scale:
Sequence Name:
Scale:
☐ LabReady
☐ LabReady
☐ LabReady
☐ LabReady
☐ LabReady
☐ LabReady
Special Instructions: __________________________________________________
___________________________________________________________________
Fax: 1-319-626-8444
Web Site: www.idtdna.com
Phone: 1-800-328-2661
ORE-032 REV 04