THE CLEVELAND CLINIC FOUNDATION
LERNER RESEARCH INSTITUTE
Molecular Biotechnology Core
BIACORE 3000 Usage form
Section A
Date: _________
Primary Investigator: ____________ User Name: _______________
Institution & Affiliation: ________________ Department: _______________________
Cost Center/ P.O.#: _____________________________ Credit Card: (fill out Section B)
TEL: ________
FAX: _______
Mail Code: _____ E-mail: ______________
Is this request in support of a peer-reviewed or training-grant-funded research program at CCF? Yes 
No 
Section B: Aditional information is required from non-ccf/outside users
Billing Address*:_______________________________________________________________
*Note: The Billing address might be different than the address of institution or laboratory information
you provided in the first section.
Accounts Payable Contact Name________________Tel#__________________
Credit Card #:_______________________  VISA  Master Card  AMEX Discover
Expiration Date:______ Name of card holder:_________ V-code_________
Section C
Time on instrument (hours):Time IN ___________
Time OUT _________ Overnight? Yes  No 
Type of Analysis (Choose only one):
Preliminary-Feasibility:_____ Concentration:
Affinity:
Kinetics:
Binding:
Affinity ranking:
Ligand Fishing:
Are there any special conditions of Buffer, pH, storage or binding temperature required for stability of the
sample or compatibility with other measurements?
Are any of the molecules radioactive ?
Yes 
Are any of the molecules considered to be biohazard ?
Yes 
No 
No 
Note: This instrument was purchased through a shared instrumentation grant from NIH. We ask
you to acknowledge the Molecular Biotechnology Core and Dr. Satya P. Yadav for a shared NIH
grant # RR016789-01A1 in your publications that have BIACORE –performed experiments.
Molecular Biotechnology Core, NN1-13; Tel. (216) 444-5845/445-7095
THE CLEVELAND CLINIC FOUNDATION
LERNER RESEARCH INSTITUTE
Molecular Biotechnology Core
Peptide Synthesis Request Form
Date:
P.I . Name:
User Name:
Activity #/ P.O. # :
Department:
Mail Code:
Telephone #:
E-mail/ Fax:
ADITIONAL INFORMATION REQUIRED FOR NON-CCF/OUTSIDE USERS:
Billing Address*:_______________________________________________________________
______________________________________________________________________________
*Note: The Billing address might be different than the address of institution or laboratory information
you provided in the first section.
Accounts Payable Contact Name__________________ Tel#______________________
Credit Card #:____________________________________________VISA Master Card
Name of Card holder: _______________________Expiration Date: ___________

Please check (√ ) the following accordingly:
Scale of Synthesis: 50μmole
; 100μmole
;

Regular Peptide

Type of Modification *:

Crude Peptide
250μmole
; or Multiple Antigen Peptide (MAP)
.
.
; or Purified Peptide *
Please print neatly the peptide sequence(s) in this box.
.
Mass of the peptide:________
==================FOR CORE USE ONLY !===========================
Set Up:
___________
Number of Amino Acids (aas) coupled:
___________
Purified Peptide:
___________
TOTAL=
__________
Molecular Biotechnology Core, NN1-13; Tel. (216) 444-5845 / 445-7095
.
THE CLEVELAND CLINIC FOUNDATION
LERNER RESEARCH INSTITUTE
Molecular Biotechnology Core
ITC Usage form
Section A
Date: ___________
Primary Investigator: ___________________
User Name: _________________________
Institution & Affiliation: ___________________________________________
Department: _____________________
Activity Number: _____________________________________________________
TEL: ________________ FAX: _____________
E-mail: _________________________
Mail Code: ______________
Name Protein/compounds used: -------------------------; -------------------------------; -------------------------Are any of the molecules radioactive ?
Yes 
No 
Are any of the molecules considered to be biohazard ?
Yes 
No 
Time on instrument (hours): Date/s_______ Time IN _________ Time OUT ____________
Overnight? Yes  No 
Total Number of Hours used: --------------------
CORE USE ONLY
Charges for ITC200:
Usage time: _________ to __________
Hourly charge: _________________
Daily charge for consumables: _________________
Total charge: _________
CLEVELAND CLINIC FOUNDATION
THE LERNER RESEARCH INSTITUTE
Molecular Biotechnology Core
Circular Dichroism (CD) Usage Form
Date:
User Name:
P.I . Name:
Department:
Activity Number (Only for CCF
users):
Telephone #:
Mail Code:
E-mail/ Fax:
Non-CCF users (Please complete this part)
P. I. Name
User Name:
Telephone Number:
Billing address:
Credit Card / P.O. Number: VISA
Master Card
AMEX
Discover
V-code
Expiration Date:
Name of card holder:
Print time-in (when turn on nitrogen gas):____________
Print time-out (when turn-off nitrogen gas):____________
Total Number of hours:
FOR CORE USE ONLY !===========================
Training:______________________________
Independent use / assisted use: ___________
TOTAL=______________________________
Molecular Biotechnology Core, NN1-13; Tel. (216) 444-5845/445-7095