First Name
*
Last Name
*
Email
*
Company/University
Address
City
Postal Code
Country
Job Title
Research Area
*
Cancer
Cardiovascular
Cell Biology
Immunology
Metabolism
Neuroscience
Stem Cells & Dev Biology
Rare disease/disorder
Other
Product name
*
Product Number
*
Desired amount in ul, ug or mg
*
Desired Formulation
*
PBS
PBS + NaAzide (0.02%) - (NaAzide prevents growth of living forms)
Standard formulation (PBS 60% + 40% Glycerol + 0.02% NaAzide)
Desired Concentration (Write one of these: Target=___mg/mL, Minimum=___mg/mL or Maximum=___mg/mL)
*
Shipping conditions
*
No Ice
Wet ice
Dry ice (For PBS only - Extra freight cost may apply)
Others (please specify)
Shipping conditions (please specify)
Shipping carrier
DHL
Fedex
World Courier
Others
Vial size
*
Standard (110ul)
Custom (please specify)
Vial size (please specify)