Microbial Identification
Order Form
Client
Invoice Department
Your Purchase Order number #:
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ORDER (please use the sample sheet)
THE FOLLOWING OPTIONS ARE AVAILABLE, PLEASE INDICATE YOUR CHOICE ON THE SAMPLESHEET:

Identification of unknown bacteria:
PB-304(F): MicroSEQ® 500bp. The validated MicroSEQ kits and the validated MicroSEQ
bacterial databases will be used for the identification.

Identification of unknown fungi:
PB-306(F): MicroSEQ® D2-LSU. The validated MicroSEQ kits and the validated MicroSEQ
fungal databases will be used for the identification.

Pure culturing (optional):
PB-315: The impure sample/plate will be re-cultured to get pure single colonies.
Depending on the wishes of the client all the contaminants, only the unique contaminants or the
major contributor will be re-cultured
RESULTS
After the results are released by QA the report will be send by email and by regular mail.
I accept the general terms and conditions of
ProBase Pharma*
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: ______________________
Signature
: ______________________
Date
:__ / __/ ____
To be filled out by ProBase Pharma:
Project Code
: __________________
Date of registration : _ _ / _ _ / _ _ _ _
*Our General Terms and Conditions apply to all projects ProBase Pharma carries out and can be downloaded
from our website (www.probasepharma.com).
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Microbial Identification
Order Form
SAMPLES
We can only process live Class I, non-pathogenic micro-organism that are provided to us according to Dutch
regulations. In brief, this means that bacteria or fungi should be delivered on petri-dishes or on slants that are
sealed with parafilm. Sealed dishes/ slants should be wrapped in absorbing tissue, and enclosed in an
unbreakable and watertight cover. Please make sure that you clearly indicate the sample names on the petridishes. If you suspect the micro-organisms to be pathogenic please contact us beforehand so we can discuss
alternative means of transportation.
TERMS OF DELIVERY
Identification of bacterial samples using the validated MicroSEQ® system (PB-304)
DNA-isolation, PCR, sequencing and reporting will be performed using MicroSEQ validated protocols, kits and
database. Approximately 500 base pairs of the 16S rRNA gene will be amplified and sequenced on both strands.
A full report including the homology search to the MicroSEQ validated database and sequence data will be
mailed to the client within 5 working days.
The reported result is the most likely sample identification. However, the client has to make the final conclusion
to the identity of the sample.
FAST Bacterial identification using the validated MicroSEQ® system (PB-304F)
DNA-isolation, PCR, sequencing and reporting will be performed using MicroSEQ validated protocols, kits and
database. Approximately 500 base pairs of the 16S rRNA gene will be amplified and sequenced on both strands.
A full report including the homology search to the MicroSEQ validated database and sequence data will be
mailed to the client within 1 working days (when samples arrive before 15.00h).
The reported result is the most likely sample identification. However, the client has to make the final conclusion
to the identity of the sample.
Identification of fungal samples using the validated MicroSEQ® system (PB-306)
DNA-isolation, PCR, sequencing and reporting will be performed using MicroSEQ validated protocols, kits and
database. For fungal samples, the D2-LSU gene is amplified and sequenced on both strands using validated
MicroSEQ® kits and protocols. The length of the consensus sequence is approximately 200-300 bp long. A full
report including the homology search to the validated MicroSEQ database and sequence data will be mailed to
the client within 5 working days.
The reported result is the most likely sample identification. However, the client has to make the final conclusion
to the identity of the sample.
FAST Fungal identification using the validated MicroSEQ® system (PB-306F)
DNA-isolation, PCR, sequencing and reporting will be performed using MicroSEQ validated protocols, kits and
database. For fungal samples, the D2-LSU gene is amplified and sequenced on both strands using validated
MicroSEQ® kits and protocols. The length of the consensus sequence is approximately 200-300 bp long. A full
report including the homology search to the validated MicroSEQ database and sequence data will be mailed to
the client within 1 working days(when samples arrive before 15.00h).
The reported result is the most likely sample identification. However, the client has to make the final conclusion
to the identity of the sample.
Pure culturing (PB-315)
When visually more than one type of colony is present on the sample plate the client will be contacted to
discuss the different options.
-
Option 1: Continue with the original plate and use the clones that are the most common on the plate
for analysis
-
Option 2: re-culture all the different colonies to get several plates with (different) pure single colonies.
-
Option 3: re-culture only the unique contaminants
-
Option 4: re-culture only the most common colonies (major contributor)
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Microbial Identification
Order Form
Transport and Storage (To be filled in by client)
Transport:
 liquid nitrogen
 Frozen (-25C and -15°C)
 Other,
 Dry ice
 Cooled (2-8C)
Temperature logger present
 yes
Storage:
 liquid nitrogen
 Frozen (-25C and -15°C)
 Other,
 Deep frozen(<-60C)
 Cooled (2-8C)
Bacterial identification
No.
 Room temp. (15-25C)
(please specify)
 no
 Room temp. (15-25C)
(please specify)
Fungal identification
Sample name
1.
MicroSEQ® 500bp
FAST MicroSEQ® 500bp
MicroSEQ® D2-LSU
FAST MicroSEQ® D2-LSU
2.
MicroSEQ® 500bp
FAST MicroSEQ® 500bp
MicroSEQ® D2-LSU
FAST MicroSEQ® D2-LSU
3.
MicroSEQ® 500bp
FAST MicroSEQ® 500bp
MicroSEQ® D2-LSU
FAST MicroSEQ® D2-LSU
4.
MicroSEQ® 500bp
FAST MicroSEQ® 500bp
MicroSEQ® D2-LSU
FAST MicroSEQ® D2-LSU
5.
MicroSEQ® 500bp
FAST MicroSEQ® 500bp
MicroSEQ® D2-LSU
FAST MicroSEQ® D2-LSU
6.
MicroSEQ® 500bp
FAST MicroSEQ® 500bp
MicroSEQ® D2-LSU
FAST MicroSEQ® D2-LSU
7.
MicroSEQ® 500bp
FAST MicroSEQ® 500bp
MicroSEQ® D2-LSU
FAST MicroSEQ® D2-LSU
8.
MicroSEQ® 500bp
FAST MicroSEQ® 500bp
MicroSEQ® D2-LSU
FAST MicroSEQ® D2-LSU
9.
MicroSEQ® 500bp
FAST MicroSEQ® 500bp
MicroSEQ® D2-LSU
FAST MicroSEQ® D2-LSU
10.
MicroSEQ® 500bp
FAST MicroSEQ® 500bp
MicroSEQ® D2-LSU
FAST MicroSEQ® D2-LSU
Please leave
this column
empty
Remarks:
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