Fill in this form and e-mail or fax it to one of the addresses/numbers below Australia E-mail: siRNA-AU@qiagen.com Fax: 03-9840-9888 Austria E-mail: siRNA-AT@qiagen.com Fax: 0800 28-10-19 Benelux E-mail: siRNA-BNL@qiagen.com Fax: Belgium 0800-79611 Fax: Luxembourg 8002-2073 Fax: The Netherlands 0800-0229593 Brazil E-mail: vendas.brasil@qiagen.com Fax: 55-11-5079-4001 Denmark E-mail: siRNA-nordic@qiagen.com Fax: 80-885944 Finland E-mail: siRNA-nordic@qiagen.com Fax: 0800-914415 France E-mail: siRNA-FR@qiagen.com Fax: 01-60-920-925 Germany E-mail: siRNA-DE@qiagen.com Fax: 02103-29-22000 Hong Kong E-mail: orders-HK@qiagen.com Fax: 800 930 439 Italy E-mail: siRNA-IT@qiagen.com Fax: 02-33430426 Japan E-mail: order-JP@qiagen.com Fax: 03-6890-0011 Korea (South) E-mail: orders-KR@qiagen.com Fax: 1544 7146 Mexcio E-mail: ventas.Mexico@qiagen.com Fax: 01-800-1122330 Norway E-mail: siRNA-nordic@qiagen.com Fax: 800-18817 Sweden E-mail: siRNA-nordic@qiagen.com Fax: 020-790582 Switzerland E-mail: siRNA-CH@qiagen.com Fax: 055-254-22-13 UK and Ireland E-mail: siRNA-UK@qiagen.com Fax: 01293-422-922 USA and Canada E-mail: siRNA-US@qiagen.com Fax: 800 585 0216 All other countries E-mail: siRNA-international@qiagen.com Fax: +49-2103-29-13477 HP Custom siRNA Order Form This is: an order (default) Today’s date (dd/mm/yy): PO number: Customer account number (if known): Promo code (if applicable): Agreement number (if applicable): Shipping Information Billing Information Name: E-mail: Phone: Fax: Organization/Company: Dept: Address 1: Address 2: Town/City: Postal (zip) code: Country: If you would like to pay by credit card, fill in your details below: Credit Card Type: -- Please select -- Card Holder Name: Credit Card No: Expiration Date: Ordering Information: Enter sequence information as follows. Enter the 21 base DNA target, and specify whether you would like standard DNA ends, or non-standard RNA ends. We will generate the sense and antisense strands for siRNA duplex formation from the specified DNA target and will add DNA or RNA overhangs. The sequence of the overhangs will depend on the DNA sequence (see table below). Note: You must enter 21 bases into the 21 base DNA target sequence field below. (Unlike the online ordering tool, if you enter only 19 bases, 2 adenine bases will not be automatically added to the 5' end.) HPP Grade siRNA is provided >90% pure, annealed, and lyophilized. For combinations of modifications, or modifications not listed here, please contact QIAGEN Technical Services. It is not possible to cancel or change an order for custom siRNA once the order has been placed. Standard DNA ends: Non-standard RNA ends: 3'- dTdT overhang DNA target sequence starts with AA. Both strands will have a dTdT overhang. 3'-dXdY overhang DNA target sequence starts with any 2 bases (XY). The sense strand will have a dTdT overhang. The antisense strand will have a dXdY overhang (corresponding to first 2 bases of target). 3'-UU overhang DNA target sequence starts with AA. Both strands will have a UU overhang. 3'-XY overhang DNA target sequence starts with any 2 bases (XY). The sense strand will have a UU overhang. The antisense strand will have an XY overhang (corresponding to first 2 bases of target). siRNA 1. Choose a name for your siRNA sequence: 21 base DNA target sequence: 5' 3' Overhang: Standard DNA ends Amount: 20 nmol (~250 µg, one tube) Modification (one per duplex): 3' end, sense strand OR 5' end, sense strand None (default) None (default) siRNA 2. Choose a name for your siRNA sequence: 21 base DNA target sequence: 5' Overhang: Standard DNA ends Amount: 20 nmol (~250 µg, one tube) Modification (one per duplex): 3' 3' end, sense strand OR 5' end, sense strand None (default) siRNA 3. Choose a name for your siRNA sequence: 21 base DNA target sequence: 5' 3' . Page 2 of 3 None (default) Overhang: Standard DNA ends Amount: 20 nmol (~250 µg, one tube) Modification (one per duplex): 3' end, sense strand OR 5' end, sense strand None (default) None (default) siRNA 4. Choose a name for your siRNA sequence: 21 base DNA target sequence: 5' 3' Overhang: Standard DNA ends Amount: 20 nmol (~250 µg, one tube) Modification (one per duplex): 3' end, sense strand OR 5' end, sense strand None (default) None (default) siRNA 5. Choose a name for your siRNA sequence : 21 base DNA target sequence: 5' 3' Overhang: Standard DNA ends Amount: 20 nmol (~250 µg, one tube) Modification (one per duplex): 3' end, sense strand OR 5' end, sense strand None (default) None (default) Library Items Library siRNA name Amount Cat. no. Quantity 5 nmol 5 nmol 5 nmol 5 nmol 5 nmol 5 nmol 5 nmol 5 nmol 5 nmol 5 nmol Trademarks: QIAGEN® (QIAGEN Group); Alexa Fluor® (Molecular Probes, Inc.); Cy® (Amersham Biosciences). siRNA technology licensed to QIAGEN is covered by various patent applications, owned by the Massachusetts Institute of Technology, Cambridge, MA, USA and others. Visit www.qiagen.com/siRNA to find out about the range of products and services available for RNAi! . Page 3 of 3