peptide pdf order form

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www.bio-world.com laboratory ser- INDEX A-Ala C-Cys d-Asp e-Glu F-Phe g-Gly H-His I-Ile K-Lys L-Leu M-Met N-Asn P-Pro Q-Gln R-Arg S-Ser T-Thr V-Val W-Trp Y-Tyr Peptide Order Form 4150 Tuller Rd, Suite 228 Dublin, Ohio 43017 Fax: 614-792-8685 Phone: 614-792-8680 Toll Free: 800-860-9729 e-mail: [email protected] PEPTIDE 1 Peptide Name__________________________ Write Sequence N to C ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 Purification __Unpurified (15-40mg) __>70%pure (5-25mg) __>80%pure (5-15mg) __>95%pure (5-10mg) Conjugation __KLH (Keyhole Limpet Hemocyanin) __BSA(Bovine Serum Albumin) Conjugation Terminal End __ N-terminal __C-terminal Modifications___________________________________________________________________________________________________ ______________________________________________________________________________________________________________ ____________________________________________________________________ Comments___________________________________________________________ ____________________________________________________________________ ____________________________________________________________________ BILL T O: PO#________________ Customer#________ Name_________________________________________ Institution______________________________________ Department_____________________________________ Address________________________________________ ______________________________________________ City, State, Zip__________________________________ Phone_________________________________________ SHIP T O: Name_______________________________________ Institution____________________________________ Department__________________________________ Address_____________________________________ City, State, Zip________________________________ Phone_______________________________________ Fax_________________________________________ Setup (MAPONLY) $__________ AA Bases 80# ___ $__________ AA Bases >80# ___ $__________ Modifications $__________ Purification $__________ TOTAL $__________ ORDERING AND CREDIT CARD INFORMA TION ___VISA ___Mastercard Amount $__________ + Shipping $____________= TOTAL $____________ Card Number_______________________________________ Expiration Date__________ Cardholder Name (as it appears on card) _________________________ Signature__________________________________________ Modification Acetylation $65.50 Amidation(C-terminal) $50.00 Benzyloxycarbonylation $48.00 Biotin $150.00 Dansylation $60.00 Dinitrobenzoylation(DNP) $60.00 Fatty Acid $48.00 Formylation $160.00 Nitronation $120.00 Phosphorylation-Serine $160.00 Phosphorylation-Threonine $160.00 Phosphorylation-Tyrosine $160.00 Multiple Antigenic Peptide (MAP) System Set-Up Fee (ALL MAPPEPTIDES) $75.00 Asymmetric 4 branches $275.00 Symmetric 4 branches $285.00 Asymmetric 8 branches $295.00 Symmetric 8 branches $295.00 Purification Unpurified (Greater than 60% Pure) $0.00 Greater than 70% Pure $170.00 Greater than 80% Pure $210.00 Greater than 95% Pure $260.00 Succinylation $60.00 Sulfonation $485.00 Fluorescence/Dye labeling Aminocoumarin $200.00 Biodipy $350.00 Fluorescein $200.00 Lissamine $250.00 Rhodamine $195.00 NBD $250.00 Tetramethylrhodamine $200.00 Protein Carrier Conjugation KLH(Keyhole Limpet Hemocyanin $245.00 BSA(Bovine Serum Albumin) $245.00 Please fill out form as completely as possible.

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Peptide order form : Peptide synthesis , Peptide Production ,Peptide Sequence ,Multiple Antigenic Peptide(MAP) System ,Protein Carrier Conjugation,Fluorescence/Dye labeling

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Page 1: Peptide pdf order form

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INDEX

A-Ala

C-Cys

d-Asp

e-Glu

F-Phe

g-Gly

H-His

I-Ile

K-Lys

L-Leu

M-Met

N-Asn

P-Pro

Q-Gln

R-Arg

S-Ser

T-Thr

V-Val

W-Trp

Y-Tyr

Peptide Order Form4150 Tuller Rd, Suite 228Dublin, Ohio 43017 Fax: 614-792-8685Phone: 614-792-8680Toll Free: 800-860-9729e-mail: [email protected]

PEPTIDE 1 Peptide Name__________________________ Write Sequence N to C

___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 2 5

___ ___ ___ ___ ___ ___ ___ _ _ _ _ _ _ ___ ___ ___ _ _ _ _ _ _ _ _ _ _ _ _ ___ ___ ___ ___ _ _ _ ___ ___ ___ ___ 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50

Purification __Unpurified (15-40mg) __>70%pure (5-25mg) __>80%pure (5-15mg) __>95%pure (5-10mg)

Conjugation __KLH (Keyhole Limpet Hemocyanin) __BSA(Bovine Serum Albumin)

Conjugation Terminal End __ N-terminal __C-terminal

Modifications___________________________________________________________________________________________________

______________________________________________________________________________________________________________

____________________________________________________________________

Comments___________________________________________________________

____________________________________________________________________

____________________________________________________________________

BILL TO: PO#________________ Customer#________Name_________________________________________Institution______________________________________Department__ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _Address_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _______________________________________________City, State, Zip__________________________________Phone_________________________________________

SHIP TO:Name_______________________________________Institution____________________________________Department__________________________________Address_____________________________________City, State, Zip________________________________Phone_______________________________________Fax_________________________________________

Setup (MAPONLY) $__________AA Bases ≤80# ___ $__________AA Bases >80# ___ $__________Modifications $__________Purification $__________

TOTAL $__________

ORDERING AND CREDIT CARD INFORMATION ___VISA ___Mastercard

Amount $__________ + Shipping $____________= TOTAL $____________

Card Number_______________________________________ Expiration Date__________

Cardholder Name (as it appears on card)_________________________ Signature__________________________________________

ModificationAcetylation $65.50Amidation(C-terminal) $50.00Benzyloxycarbonylation $48.00Biotin $150.00Dansylation $60.00Dinitrobenzoylation(DNP) $60.00Fatty Acid $48.00Formylation $160.00Nitronation $120.00Phosphorylation-Serine $160.00Phosphorylation-Threonine $160.00Phosphorylation-Tyrosine $160.00

Multiple Antigenic Peptide (MAP) System

Set-Up Fee (ALL MAPPEPTIDES) $75.00Asymmetric 4 branches $275.00Symmetric 4 branches $285.00Asymmetric 8 branches $295.00Symmetric 8 branches $295.00

PurificationUnpurified (Greater than 60% Pure) $0.00Greater than 70% Pure $170.00Greater than 80% Pure $210.00Greater than 95% Pure $260.00

Succinylation $60.00Sulfonation $485.00

Fluorescence/Dye labelingAminocoumarin $200.00Biodipy $350.00Fluorescein $200.00Lissamine $250.00Rhodamine $195.00NBD $250.00Tetramethylrhodamine $200.00

Protein Carrier ConjugationKLH(Keyhole Limpet Hemocyanin $245.00BSA(Bovine Serum Albumin) $245.00

P l e a s e f i l l o u t f o r m a s c o m p l e t e l y a s p o s s i b l e .

Page 2: Peptide pdf order form

INDEX

INDEX

A-Ala F-Phe K-Lys P-Pro T-Thr

C-Cys g-Gly L-Leu Q-Gln V-Val

d-Asp H-His M-Met R-Arg W-Trp

e-Glu I-Ile N-Asn S-Ser Y-Tyr

4150 Tuller Rd, Suite 228 • Dublin, Ohio 43017 • Phone: 614-792-8680 • Toll Free: 800-860-9729 • Fax: 614-792-8685 • save@ b i o - w o r l d . c o m

PEPTIDE 2 Peptide Name__________________________ Write Sequence N to C

___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 2 5

___ ___ ___ ___ ___ ___ ___ _ _ _ _ _ _ ___ ___ ___ _ _ _ _ _ _ _ _ _ _ _ _ ___ ___ ___ ___ _ _ _ ___ ___ ___ ___ 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50

Purification __Unpurified (15-40mg) __>70%pure (5-25mg) __>80%pure (5-15mg) __>95%pure (5-10mg)

Conjugation __KLH (Keyhole Limpet Hemocyanin) __BSA (Bovine Serum Albumin)

Conjugation Terminal End __ N-terminal __C-terminal

Modifications/Comments:_________________________________________________________________________________________

__ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

______________________________________________________________________________________________________________

PEPTIDE 3 Peptide Name__________________________ Write Sequence N to C

___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 2 5

___ ___ ___ ___ ___ ___ ___ _ _ _ _ _ _ ___ ___ ___ _ _ _ _ _ _ _ _ _ _ _ _ ___ ___ ___ ___ _ _ _ ___ ___ ___ ___ 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50

Purification __Unpurified (15-40mg) __>70%pure (5-25mg) __>80%pure (5-15mg) __>95%pure (5-10mg)

Conjugation __KLH (Keyhole Limpet Hemocyanin) __BSA (Bovine Serum Albumin)

Conjugation Terminal End __ N-terminal __C-terminal

Modifications/Comments:_________________________________________________________________________________________

__ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

______________________________________________________________________________________________________________

PEPTIDE 4 Peptide Name__________________________ Write Sequence N to C

___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 2 5

___ ___ ___ ___ ___ ___ ___ _ _ _ _ _ _ ___ ___ ___ _ _ _ _ _ _ _ _ _ _ _ _ ___ ___ ___ ___ _ _ _ ___ ___ ___ ___ 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50

Purification __Unpurified (15-40mg) __>70%pure (5-25mg) __>80%pure (5-15mg) __>95%pure (5-10mg)

Conjugation __KLH (Keyhole Limpet Hemocyanin) __BSA (Bovine Serum Albumin)

Conjugation Terminal End __ N-terminal __C-terminal

Modifications/Comments:_________________________________________________________________________________________

__ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

______________________________________________________________________________________________________________

Peptide Order Form continued Use this form for additional peptide sequences.

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