Please use this form to enter details of the templates you are sending for sequencing. After completing this form, use your print function, insert the printed form with your templates and press the continue button at the bottom of the page. This will display the information you entered. If info is incorrect, press the "back" key and make corrections. If info is correct, click on the "Submit this Order" button at the bottom of the page. You will receive an e-mail confirmation of your order at the e-mail address you gave on this form.

Name: Company:
Billing  Address:
City: State and ZIP:
Department:Phone:
P.O. Number:
Payment Source: {Select Source} State Funding NIH Grant Funding NSF Grant Funding Other Grant Funding Other
e-mail address:

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Plasmid name #1
Plasmid Name or Code:
Parent Vector (if known):
Plasmid Concentration (µg/µl): Insert Size (base pairs):
Primer name (s)
Dye primer SBS Dye primer UNIDye terminator
Manual EditingYes No TIFF image

*If dye terminator is requested, fill out the following*
Primer sequence
Prime Tm (if known):Primer concentration (mg/ml)

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Plasmid name #2
Plasmid Name or Code:
Parent Vector (if known):
Plasmid Concentration (µg/µl): Insert Size (base pairs):
Primer name (s)
Dye primer SBS Dye primer UNIDye terminator
Manual EditingYes No TIFF image

*If dye terminator is requested, fill out the following*
Primer sequence
Prime Tm (if known):Primer concentration (mg/ml)

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Plasmid name #3
Plasmid Name or Code:
Parent Vector (if known):
Plasmid Concentration (µg/µl): Insert Size (base pairs):
Primer name (s)
Dye primer SBS Dye primer UNIDye terminator
Manual EditingYes No TIFF image

*If dye terminator is requested, fill out the following*
Primer sequence
Prime Tm (if known):Primer concentration (mg/ml)

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Plasmid name #4
Plasmid Name or Code:
Parent Vector (if known):
Plasmid Concentration (µg/µl): Insert Size (base pairs):
Primer name (s)
Dye primer SBS Dye primer UNIDye terminator
Manual EditingYes No TIFF image

*If dye terminator is requested, fill out the following*
Primer sequence
Prime Tm (if known):Primer concentration (mg/ml)

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Plasmid name #5
Plasmid Name or Code:
Parent Vector (if known):
Plasmid Concentration (µg/µl): Insert Size (base pairs):
Primer name (s)
Dye primer SBS Dye primer UNIDye terminator
Manual EditingYes No TIFF image

*If dye terminator is requested, fill out the following*
Primer sequence
Prime Tm (if known):Primer concentration (mg/ml)

How do you want your sequence data presented? Check either or both. ascii file trace file

Special Instructions for Sequencing
Alignment Instructions (If required)