DNA Sequencing Request Form.

If you want to submit more than 20 samples at a time, please make another request.

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Note: italicized fields are mandatory.

P. I. Name: Last	First
User Name: Last	First

Lab Address:

PTAO#: - - - Please check if new Account

Department: Institute (If not UVa)

Requested Date (MM/DD/YY):

Total number of samples in this form(No more than 20):

Data Delivery method: E-mail/Text+PDF Zip Disk FTP/Mac-Mac E-mail/Text+ABI E-mail/Text+ABI+PDF

Phone #: Fax #:

E-mail address:

Order Comments (add billing address here for external orders):

Enter your sample information below.

#	Sample Name (<=8 typespaces)	Primer	Bank?	Vector Type	Purf. Meth.	Comments
1		Choose a bank primer T7 SP6 T3 SK KS M13/pUC(-21) Fwd M13/pUC Rev pGEX Fwd pGEX Rev CMV Fwd p(dT)20N Firfly luc. Ups EGFP N EGFP C pcDNA3.1/BGH Rev T7 terminater GLP-clockwise GLP-countercl. SV40-clockwise SV40-countercl. Others -- use comments	Yes No	Plasmid Single stranded PCR Amplicon Lambda BAC PAC	Qiagen Promega Alkaline_PEG BioRad other
2		Choose a bank primer T7 SP6 T3 SK KS M13/pUC(-21) Fwd M13/pUC Rev pGEX Fwd pGEX Rev CMV Fwd p(dT)20N Firfly luc. Ups EGFP N EGFP C pcDNA3.1/BGH Rev T7 terminater GLP-clockwise GLP-countercl. SV40-clockwise SV40-countercl. Others -- use comments	Yes No	Plasmid Single stranded PCR Amplicon Lambda BAC PAC	Qiagen Promega Alkaline_PEG BioRad other
3		Choose a bank primer T7 SP6 T3 SK KS M13/pUC(-21) Fwd M13/pUC Rev pGEX Fwd pGEX Rev CMV Fwd p(dT)20N Firfly luc. Ups EGFP N EGFP C pcDNA3.1/BGH Rev T7 terminater GLP-clockwise GLP-countercl. SV40-clockwise SV40-countercl. Others -- use comments	Yes No	Plasmid Single stranded PCR Amplicon Lambda BAC PAC	Qiagen Promega Alkaline_PEG BioRad other
4		Choose a bank primer T7 SP6 T3 SK KS M13/pUC(-21) Fwd M13/pUC Rev pGEX Fwd pGEX Rev CMV Fwd p(dT)20N Firfly luc. Ups EGFP N EGFP C pcDNA3.1/BGH Rev T7 terminater GLP-clockwise GLP-countercl. SV40-clockwise SV40-countercl. Others -- use comments	Yes No	Plasmid Single stranded PCR Amplicon Lambda BAC PAC	Qiagen Promega Alkaline_PEG BioRad other
5		Choose a bank primer T7 SP6 T3 SK KS M13/pUC(-21) Fwd M13/pUC Rev pGEX Fwd pGEX Rev CMV Fwd p(dT)20N Firfly luc. Ups EGFP N EGFP C pcDNA3.1/BGH Rev T7 terminater GLP-clockwise GLP-countercl. SV40-clockwise SV40-countercl. Others -- use comments	Yes No	Plasmid Single stranded PCR Amplicon Lambda BAC PAC	Qiagen Promega Alkaline_PEG BioRad other
6		Choose a bank primer T7 SP6 T3 SK KS M13/pUC(-21) Fwd M13/pUC Rev pGEX Fwd pGEX Rev CMV Fwd p(dT)20N Firfly luc. Ups EGFP N EGFP C pcDNA3.1/BGH Rev T7 terminater GLP-clockwise GLP-countercl. SV40-clockwise SV40-countercl. Others -- use comments	Yes No	Plasmid Single stranded PCR Amplicon Lambda BAC PAC	Qiagen Promega Alkaline_PEG BioRad other
7		Choose a bank primer T7 SP6 T3 SK KS M13/pUC(-21) Fwd M13/pUC Rev pGEX Fwd pGEX Rev CMV Fwd p(dT)20N Firfly luc. Ups EGFP N EGFP C pcDNA3.1/BGH Rev T7 terminater GLP-clockwise GLP-countercl. SV40-clockwise SV40-countercl. Others -- use comments	Yes No	Plasmid Single stranded PCR Amplicon Lambda BAC PAC	Qiagen Promega Alkaline_PEG BioRad other
8		Choose a bank primer T7 SP6 T3 SK KS M13/pUC(-21) Fwd M13/pUC Rev pGEX Fwd pGEX Rev CMV Fwd p(dT)20N Firfly luc. Ups EGFP N EGFP C pcDNA3.1/BGH Rev T7 terminater GLP-clockwise GLP-countercl. SV40-clockwise SV40-countercl. Others -- use comments	Yes No	Plasmid Single stranded PCR Amplicon Lambda BAC PAC	Qiagen Promega Alkaline_PEG BioRad other
9		Choose a bank primer T7 SP6 T3 SK KS M13/pUC(-21) Fwd M13/pUC Rev pGEX Fwd pGEX Rev CMV Fwd p(dT)20N Firfly luc. Ups EGFP N EGFP C pcDNA3.1/BGH Rev T7 terminater GLP-clockwise GLP-countercl. SV40-clockwise SV40-countercl. Others -- use comments	Yes No	Plasmid Single stranded PCR Amplicon Lambda BAC PAC	Qiagen Promega Alkaline_PEG BioRad other
10		Choose a bank primer T7 SP6 T3 SK KS M13/pUC(-21) Fwd M13/pUC Rev pGEX Fwd pGEX Rev CMV Fwd p(dT)20N Firfly luc. Ups EGFP N EGFP C pcDNA3.1/BGH Rev T7 terminater GLP-clockwise GLP-countercl. SV40-clockwise SV40-countercl. Others -- use comments	Yes No	Plasmid Single stranded PCR Amplicon Lambda BAC PAC	Qiagen Promega Alkaline_PEG BioRad other
11		Choose a bank primer T7 SP6 T3 SK KS M13/pUC(-21) Fwd M13/pUC Rev pGEX Fwd pGEX Rev CMV Fwd p(dT)20N Firfly luc. Ups EGFP N EGFP C pcDNA3.1/BGH Rev T7 terminater GLP-clockwise GLP-countercl. SV40-clockwise SV40-countercl. Others -- use comments	Yes No	Plasmid Single stranded PCR Amplicon Lambda BAC PAC	Qiagen Promega Alkaline_PEG BioRad other
12		Choose a bank primer T7 SP6 T3 SK KS M13/pUC(-21) Fwd M13/pUC Rev pGEX Fwd pGEX Rev CMV Fwd p(dT)20N Firfly luc. Ups EGFP N EGFP C pcDNA3.1/BGH Rev T7 terminater GLP-clockwise GLP-countercl. SV40-clockwise SV40-countercl. Others -- use comments	Yes No	Plasmid Single stranded PCR Amplicon Lambda BAC PAC	Qiagen Promega Alkaline_PEG BioRad other
13		Choose a bank primer T7 SP6 T3 SK KS M13/pUC(-21) Fwd M13/pUC Rev pGEX Fwd pGEX Rev CMV Fwd p(dT)20N Firfly luc. Ups EGFP N EGFP C pcDNA3.1/BGH Rev T7 terminater GLP-clockwise GLP-countercl. SV40-clockwise SV40-countercl. Others -- use comments	Yes No	Plasmid Single stranded PCR Amplicon Lambda BAC PAC	Qiagen Promega Alkaline_PEG BioRad other
14		Choose a bank primer T7 SP6 T3 SK KS M13/pUC(-21) Fwd M13/pUC Rev pGEX Fwd pGEX Rev CMV Fwd p(dT)20N Firfly luc. Ups EGFP N EGFP C pcDNA3.1/BGH Rev T7 terminater GLP-clockwise GLP-countercl. SV40-clockwise SV40-countercl. Others -- use comments	Yes No	Plasmid Single stranded PCR Amplicon Lambda BAC PAC	Qiagen Promega Alkaline_PEG BioRad other
15		Choose a bank primer T7 SP6 T3 SK KS M13/pUC(-21) Fwd M13/pUC Rev pGEX Fwd pGEX Rev CMV Fwd p(dT)20N Firfly luc. Ups EGFP N EGFP C pcDNA3.1/BGH Rev T7 terminater GLP-clockwise GLP-countercl. SV40-clockwise SV40-countercl. Others -- use comments	Yes No	Plasmid Single stranded PCR Amplicon Lambda BAC PAC	Qiagen Promega Alkaline_PEG BioRad other
16		Choose a bank primer T7 SP6 T3 SK KS M13/pUC(-21) Fwd M13/pUC Rev pGEX Fwd pGEX Rev CMV Fwd p(dT)20N Firfly luc. Ups EGFP N EGFP C pcDNA3.1/BGH Rev T7 terminater GLP-clockwise GLP-countercl. SV40-clockwise SV40-countercl. Others -- use comments	Yes No	Plasmid Single stranded PCR Amplicon Lambda BAC PAC	Qiagen Promega Alkaline_PEG BioRad other
17		Choose a bank primer T7 SP6 T3 SK KS M13/pUC(-21) Fwd M13/pUC Rev pGEX Fwd pGEX Rev CMV Fwd p(dT)20N Firfly luc. Ups EGFP N EGFP C pcDNA3.1/BGH Rev T7 terminater GLP-clockwise GLP-countercl. SV40-clockwise SV40-countercl. Others -- use comments	Yes No	Plasmid Single stranded PCR Amplicon Lambda BAC PAC	Qiagen Promega Alkaline_PEG BioRad other
18		Choose a bank primer T7 SP6 T3 SK KS M13/pUC(-21) Fwd M13/pUC Rev pGEX Fwd pGEX Rev CMV Fwd p(dT)20N Firfly luc. Ups EGFP N EGFP C pcDNA3.1/BGH Rev T7 terminater GLP-clockwise GLP-countercl. SV40-clockwise SV40-countercl. Others -- use comments	Yes No	Plasmid Single stranded PCR Amplicon Lambda BAC PAC	Qiagen Promega Alkaline_PEG BioRad other
19		Choose a bank primer T7 SP6 T3 SK KS M13/pUC(-21) Fwd M13/pUC Rev pGEX Fwd pGEX Rev CMV Fwd p(dT)20N Firfly luc. Ups EGFP N EGFP C pcDNA3.1/BGH Rev T7 terminater GLP-clockwise GLP-countercl. SV40-clockwise SV40-countercl. Others -- use comments	Yes No	Plasmid Single stranded PCR Amplicon Lambda BAC PAC	Qiagen Promega Alkaline_PEG BioRad other
20		Choose a bank primer T7 SP6 T3 SK KS M13/pUC(-21) Fwd M13/pUC Rev pGEX Fwd pGEX Rev CMV Fwd p(dT)20N Firfly luc. Ups EGFP N EGFP C pcDNA3.1/BGH Rev T7 terminater GLP-clockwise GLP-countercl. SV40-clockwise SV40-countercl. Others -- use comments	Yes No	Plasmid Single stranded PCR Amplicon Lambda BAC PAC	Qiagen Promega Alkaline_PEG BioRad other

Before submitting this form, please print out a hard copy and attach it to the samples to be delivered to the DNA sequencing lab.

After hitting the Submit button, please wait for confirmation page to appear. Bring in the samples along with the printed form to the DNA Sequencing Lab (Note that we have moved to Room 1076 Jordan Hall). Our hours are 9:00-5:00 Monday-Friday, although we are often open earlier and later (you may call before you come if you will be in the off hours).

Last updated on 8/27/07