1. Please complete and email this form to bioprocess@genscript.com
2. Our Account Manager will contact you with a quote.
If you have registered an account with GenScript, you can identify yourself by giving us your name and email address or
Account No.
Name:
Account No.:
Phone:
Organization:
Shipping Address:
(Necessary to determine shipping cost)
Email Address:
Name of Target Gene: NCBI Accession Number (Gene ID):
DNA Sequence for Targeting
Does KO of the target gene affect cell growth?
Yes No Not sure
If yes, how to rescue the KO clones:____________________________________________________________
Does KO of the target gene affect cell survival?
Yes No Not sure
Name of Host Cell Line:
A375 CHO-K1 HCT116 HEK293 HEK293T Hela
HEP-2 HEP G2 MDCKII U2OS Vero76
What is the suggested method for cell transfection?
Chemical transfection, please specify the reagent:_________________
Electroporation, please specify the program:_________________
Nucleofection, please specify the kit and program:_________________
Please provide transfection efficiency (if possible):____________________________________________
What are the medium and additives for cell growth?
Medium:______________________________________________________
Additives:_____________________________________________________
Growth condition of host cell line? Adherent Suspension Both
Please provide cell doubling time:____________________________________
Resistance of the provided host cell line? G418 Puromycin Zeocin Hygromycin B
Blasticidin S Other__________ No resistance.

Can the cell line form single cell clones? Yes No Not sure
Will serial dilution affect cell growth rate? Yes No Not sure
Do you need GenScript to follow any special cell culture routine?
Yes, see below No
Please provide the protocol with information about the cell line and any special growth characteristics or requirements:
__________________________________________________________________________________________
Do the cells contain any human pathogen?
Yes, please specify:___________________________ No
Genotype of transgenic cell line:
Single allele Two alleles Multiple alleles (indicate number)______ All alleles (number unknown)
How many clones:
One Two Three More, please specify amount________
What is the final application of the transgenic cell line?
Gene function analysis Assay development Drug screening Other
If Other, Please indicate your specific application and requirements:_________________________________
Comments:
Is this project for grant application purpose? Yes No
When will the project start?
Immediately Within one month Within three months Half a year later