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 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 Italy E-mail: siRNA-IT@qiagen.com Fax: 02-33430426 Japan E-mail: order-JP@qiagen.com Fax: 03-5547-8688 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 GeneGlobe Order Form Gene-specific products for human, mouse, and rat Please move the cursor into a gray field before typing 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: Researcher’s contact information (if different from name in above fields): Name: E-mail: Phone: Ordering Information HP GenomeWide siRNAs and HP Validated siRNAs can be ordered at 5 nmol or 20 nmol scales. Modifications are only available at the 20 nmol scale. One modification can be ordered per siRNA for the sense strand only. HP GenomeWide siRNA comes with a one-time–only replacement offer. If 2 or more HP GenomeWide siRNAs for the same target gene are ordered and none of the siRNAs result in gene silencing, QIAGEN will provide 2 additional siRNAs free of charge, once only. You will be asked to provide supporting data, demonstrating that the siRNA failed to knock down the target gene by at least 70% at the mRNA level under appropriate transfection conditions. Supporting data should include transfection efficiency data, quantitative silencing data, and data showing ≥70% knockdown of a positive control. For redesign and resynthesis of modified siRNA, you will be charged only for the cost of the modification. Published Library siRNA can be ordered at the 5 nmol scale. HP GenomeWide siRNA and HP Validated siRNA siRNA name: Amount: 5 nmol Cat. no.: Modification (one per siRNA, only available for 20 nmol): 3' end, sense strand OR 5' end, sense strand None (default) None (default) siRNA name: Amount: 5 nmol Cat. no.: Modification (one per siRNA, only available for 20 nmol): 3' end, sense strand OR 5' end, sense strand None (default) None (default) siRNA name: Amount: 5 nmol Cat. no.: Modification (one per siRNA, only available for 20 nmol): 3' end, sense strand OR 5' end, sense strand None (default) None (default) siRNA name: Amount: 5 nmol Cat. no.: Modification (one per siRNA, only available for 20 nmol): 3' end, sense strand OR 5' end, sense strand None (default) None (default) Page 2 of 3 siRNA name: Amount: 5 nmol Cat. no.: Modification (one per siRNA, only available for 20 nmol): 3' end, sense strand OR 5' end, sense strand None (default) None (default) siRNA name: Amount: 5 nmol Cat. no.: Modification (one per siRNA, only available for 20 nmol): 3' end, sense strand OR 5' end, sense strand None (default) None (default) Other gene-specific products (Published Library siRNA (5 nmol), QuantiTect® Primer Assays, QuantiTect Gene Expression Assays, and LiquiChip® assay kits) Product name Cat. no. Quantity Trademarks: QIAGEN®, LiquiChip®, QuantiTect® (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. QuantiTect Primer Assays are optimized for use in the Polymerase Chain Reaction (PCR) covered by patents owned by Roche Molecular Systems, Inc. and F. Hoffmann-La Roche, Ltd. No license under these patents to use the PCR process is conveyed expressly or by implication to the purchaser by the purchase of this product. A license to use the PCR process for certain research and development activities accompanies the purchase of certain reagents from licensed suppliers such as QIAGEN, when used in conjunction with an Authorized Thermal Cycler, or is available from Applied Biosystems. Further information on purchasing licenses to practice the PCR process may be obtained by contacting the Director of Licensing, Applied Biosystems, 850 Lincoln Centre Drive, Foster City, California 94404 or at Roche Molecular Systems, Inc., 1145 Atlantic Avenue, Alameda, California 94501. QuantiTect Gene Expression Assays or portions hereof are subject to proprietary rights of Epoch Biosciences, Inc. and are made and sold under license from Epoch under the patents and patent applications as may be designated by Epoch from time to time set forth, including one or more of the following: U.S. Patent Nos. 5,801,155, 6,084,102, 6,312,894, 6,426,408, and 6,127,121, and applications currently pending. Purchase of this product carries with it a limited, non-transferable, non-exclusive (without the right to resell, repackage, or sublicense) license under U.S. Patent Nos. 6,030,787; 5,723,591; and 5,876,930, and corresponding foreign patents. 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