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