Manual Patch Clamp Testing Service Quotation Form Instructions 1. Please complete and email this form together with the supporting materials to bioassay@genscript.com 2. Our service representative will contact you with the quote Customer Information Name: Phone: Institution: Shipping address (needed to determine shipping cost): Email: IC50 Determination Service Specifications Information (SC1310) Ion Channel: hERG (Kv11.1) hKv1.5 hKv4.2 hNav1.5 hNav1.7 Number of Samples: Nature of Samples: Chemical Other, please specify: Test Concentrations: 3 conc. at n = 3 4 conc. at n = 3 Please specify: Starting conc. (highest conc.): 5 conc. at n = 2 (μM); dilution factor: . Please specify any special requirements: Project Information Is this project for grant application purpose? When will the project start? Immediately Yes No Within one month Within three months Half a year later Rapid Patch Screening Service Specifications Information (SC1309) Ion Channel: hERG (Kv11.1) hKv1.5 hKv4.2 hNav1.5 hNav1.7 Number of Samples: Nature of Samples: Chemical Other, please specify: Test Concentration: 1 conc. at n = 2 Please specify the concentration: . Please specify any special requirements: Project Information Is this project for grant application purpose? When will the project start? Immediately Yes No Within one month Within three months Half a year later Custom Assay Development Services Channel Name: DNA Sequence: Gene Accession Number: Stable Cell Line Development: GenScript provides one-stop services from gene synthesis to assay development Client provides the cDNA, and let GenScript do the rest things Other special requirement, please specify: Type of Assays: FLIPR Assays Note: FLIPR assays are a set of flurometric assay technologies which is compatible for FLIPR Tetra. Molecular Devices Inc. supplies calcium dye and membrane potential dye for ion channel assays. similar assay kits. Radioligand Binding Assay Manual Patch Clamp Assay Automated Patch Clamp Assay (QPatch 16) Please specify any special requirements: In addition, Invitrogen also supplies Project Information Is this project for grant application purpose? When will the project start? Immediately Yes No Within one month Within three months Half a year later