| Contact Information: |
| First Name and Last Name: |
* |
| PI Name: |
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| Company/Institution: |
* |
| Department: |
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| Street Address: |
* |
City, State/Province,
and Zip Code/Postal Code: |
* |
| Country: |
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| Phone: |
* |
| Email: |
* |
| Re-type Email: |
* |
| Description of Service Desired: |
| Please select from the following two type of services: |
|
Pathway-EZ™ PCR Array Service
Custom-EZ™PCR Array Service |
| If you chose Pathway-EZ™ PCR Array Service, please provide the following information: |
| Title of the PCR Array: |
|
| Species: |
Mouse
Rat
Human
|
| Number of samples to be analyzed: |
|
| If you chose Custom-EZ™PCR Array Service, please provide the following information: |
| Species: |
Mouse
Rat
Human
|
Total Number of genes
that you want to analyze: |
|
| List of genes that you want to analyze. Please provide either the official gene symbol (such
as GAPDH) or NCBI RefSeq ID (such as NM_001234) for each gene: |
|
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| Number of samples to be analyzed: |
|
| Our scientist would be happy to work with you for designing your Custom-EZ™PCR Array |
| Additional information: |
| Would you like EZ Biosystems to perform sample preparation, such as isolating RNA from tissue samples?
|
|
yes NO
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| * Description of Samples provided (The more details, the better). Check: Requirements for PCR Array Sample Preparation
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| · Purified RNA: The amount (µg), Concentration (µg/µl), Method used for purification, and others |
| · Cell pellet, Blood, Tissue, Fixed Tissue, LCM etc: Amount (µg) and other informaton
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| Verification Code: |
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