JOINT GENOMIC CENTER
8 Dragan Tsankov blvd, 1164 Sofia, Bulgaria
Е-mail: dna@jgc-bg.org
tel. +359 2/ 819 39 83
fax +359 2/ 819 39 88
Fragment Analysis Request Form
№ … / …………..(dd/mm/yyyy)
Filled by the client
User information
First Name and Family Name of the Client:
University/Institute/Company:
Department/Section:
Tel:
Е-mail:
Fax:
Way of
payment:
Invoice
details:
Cash
Bank transfer
Prepaid account at JGC
account №
Joint project with JGC
account №
Contract with JGC
account №
For organizations registered in Bulgaria
For organizations registered outside Bulgaria
Organization:
Address:
BULSTAT:
VAT number:
Financially Liable Person:
Person who obtains the results from
analysis:
Organization:
Address:
VAT number:
Person who obtains the results from analysis:
Request submission date:
Filled by JGC
Sample received by:
Signature
Date
Notes
Sample analyzed by:
Signature
Date
Notes
1 of 2
JOINT GENOMIC CENTER
8 Dragan Tsankov blvd, 1164 Sofia, Bulgaria
Е-mail: dna@jgc-bg.org
tel. +359 2/ 819 39 83
fax +359 2/ 819 39 88
Filled by the client:
Type of service
Fragment analysis
Full PCR plate price (48-94 samples)
½ PCR plate price (25-48 samples)
¼ PCR plate price (1-24 samples)
Filled by the client when submitting samples in PCR tubes!
Please, fill in sample names in the JGC Fragment Analysis Sample EN form when submitting the samples in a
96-well PCR plate!
Sample information 1
Sample name
Fluorescent Dye
6-FAM, VIC, NED, PET
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
6-FAM
6-FAM
6-FAM
6-FAM
6-FAM
6-FAM
6-FAM
6-FAM
6-FAM
6-FAM
6-FAM
6-FAM
6-FAM
6-FAM
6-FAM
6-FAM
6-FAM
6-FAM
6-FAM
6-FAM
6-FAM
VIC
VIC
VIC
VIC
VIC
VIC
VIC
VIC
VIC
VIC
VIC
VIC
VIC
VIC
VIC
VIC
VIC
VIC
VIC
VIC
VIC
NED
NED
NED
NED
NED
NED
NED
NED
NED
NED
NED
NED
NED
NED
NED
NED
NED
NED
NED
NED
NED
Expected fragment length
(bp)
PET
PET
PET
PET
PET
PET
PET
PET
PET
PET
PET
PET
PET
PET
PET
PET
PET
PET
PET
PET
PET
Copy/ paste add the necessary number of rows
1
Detailed information regarding the procedure and terms of sample submission is available at the internet address of JGC (www.jgc-bg.org)
Notes:
- It is necessary to supply at least 10 µL of DNA solution for a single fragment analysis sample
- Give unique name to each sample. Spaces ARE NOT allowed in sample names. Please, use the symbol "_"
if necessary. Please, give short names to the samples, preferably consecutive numbers (e.g. 1, 2, 3…) in
order to secure efficient sample processing. Designate clearly the sample tubes.
- We DO NOT accept any sample with potential biohazard
- Samples are submitted protected from light
- Submit all samples in a plastic bag with the current form attached to it
2 of 2