WGS LLC Service Request Form
2629 Townsgate Road, Suite 235, Westlake Village, CA 91361
Email: info@wgs30.com; phone: 1 (818) 669-5688
Please include a copy of this form in your package and email a copy to info@wgs30.com
REQUESTOR INFORMATION
Principal Investigator:
Phone:
Email:
Institution/Department:
Dept.
Street Address:
City:
State:
Zip Code:
Research Coordinator:
Phone:
Email:
Please fill out completely and in detail in order to avoid processing delays.
EXPERIMENTAL INFORMATION
Date of Request:
Project Name:
Project Description:
Application Type (e.g., RNA-Seq, DNA-Seq, etc.):
Application System:
 Illumina HiSeq X Ten  Illumina HiSeq 2000/2500  MiSeq
Sample Submitted:
 gDNA
 Total RNA
 mRNA
 Other - please specify
DNA or RNA extraction method / Library preparation method:
 Small RNA
 NextSeq500  Ion Torrent PGM  Microarray
 DNA Library
 ChIP Library
Reference Genome/Species:
Concentration Measured By:
For NGS
 Nanodrop
Requested Library Prep:
 Qubit
 Bioanalyzer
 Single Read
 qPCR
 Paired End
 Other:
 Barcoded
 Other:
Depth of Coverage Required/Number of Reads:
Read Length (e.g., 1X50, 1x75, 1x100, 2X50, 2x75, 2X100, 2x150, 2x250):
For microarray services, please indicate the array type:
For other services, please specify:
CMC Next Generation Sequencing Service Request Form, (Rev, 1/2015)
If samples submitted have not been QC’d, additional charges will apply. If traces are available, please attach to this form.
SAMPLE INFORMATION
Sample #
Sample Name
Concentration
(ng/L)
260/280
Ratio
Volume
(L)
Multiplex Group
(Ex: A, B, etc.)
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
CMC Next Generation Sequencing Service Request Form, (Rev, 1/2015)
Additional Info (e.g., barcode)