FAX ORDER FORM
Ship to Address
First Name:
Last Name:
Department:
Organization:
Address Line 1:
Address Line 2:
City:
Post Code:
Country:
Telephone:
Fax:
Email:
Payment Information
Credit Card #:
Name on Card:
Expiration Date:
Purchase Order Number:
OligoCard Number:
Quote Number:
VAT Registration No:
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:
Bill to Address
Same as Ship To Address:
Organization:
Address Line 1:
Address Line 2:
City:
Post Code:
Country:
Telephone:
Fax:
Email:
Sequence Name:
Scale:
http://www.idtdna.com/pages/support/technical-vault/reading-room/quickreference/all-modifications
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 +32(0)16282280
Sequence: ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___
___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___
___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___
___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___
___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___
Sequence Name:
Scale:
Sequence: ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___
___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___
___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___
___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___
___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___
Purification:
☐LabReady
Purification:
☐ LabReady
Special Instructions: __________________________________________________
___________________________________________________________________
Fax: +32 (0) 16 28 22 80
Web Site: eu.idtdna.com
Phone: +32 (0) 16 28 22 60
ORE-LEU-032 REV06
Sequence Name:
Scale:
Sequence: ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___
___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___
___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___
___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___
___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___
Sequence Name:
Scale:
Sequence:
___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___
___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___
___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___
___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___
___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___
Sequence Name:
Scale:
Sequence:
___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___
___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___
___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___
___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___
___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___
Sequence Name:
Scale:
Sequence:
___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___
___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___
___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___
___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___
___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___
Sequence Name:
Scale:
Sequence:
___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___
___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___
___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___
___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___
___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___
Sequence Name:
Scale:
Sequence:
___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___
___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___
___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___
___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___
___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___
Sequence Name:
Scale:
Sequence:
___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___
___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___
___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___
___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___
___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___
Purification:
☐ LabReady
Purification:
☐ LabReady
Purification:
☐ LabReady
Purification:
☐ LabReady
Purification:
☐ LabReady
Purification:
☐ LabReady
Purification:
☐ LabReady
Special Instructions: __________________________________________________
___________________________________________________________________
Fax: +32 (0) 16 28 22 80
Web Site: eu.idtdna.com
Phone: +32 (0) 16 28 22 60
ORE-LEU-032 REV06