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HHMI / Keck Biotechnology Resource Laboratory

Protein Digestion/Identification Sample Submission Form

Order Date:

 

 

 

 

 

 

 

MM

DD

YY

 

Your Name:

 

 

 

 

 

Last Name

 

First Name

 

MI

PI Name:

 

 

 

 

 

Last Name

 

First Name

 

MI

 

Department:

 

Institution:

 

Room #:

 

Building:

 

 

Telephone:

(           )           -

Fax:

(           )           -

E-mail:

 

 

Billing Address:

(Required)

 

 

 

 

 

 

 

 

 

Street Address

 

City, State

 

Zip Code

Shipping Address:

 

 

 

 

 

 

 

 

 

Street Address

 

City, State

 

Zip Code

Yale Charging Instructions:

Project

Task

Award

Expenditure Type

Organization

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

8

3

3

6

0

0

 

 

 

 

 

 

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Check here if charging to HHMI

 

Non-Yale Charging Instructions:

Required Charging Instructions (Check one):

 

P.O. Number-Amount:

$

 

 

HHMI

 

 

Credit Card

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Enter a Purchase Order Number, a 6-digit HHMI Cost Center Number, or a Visa/Mastercard Number and Expiration Date. Please indicate whether the charging instructions refer to a P.O. Number, HHMI, or a Credit Card above. Indicate P.O. Amount if applicable.

Description of Samples

Name

(6 letter maximum)

Source (human, yeast, etc).

Estimated Amount

Monomer Mass (kD)

%CHO

(w/w)

Biohazard?1

Radioactive?1

If gel sample, give:

µg

pmol

Gel thickness (mm)

% Polyacrylamide