Service Request Form

* Laboratory Head: * Researcher: * E-mail Address: * Telephone: Service Requested: Affymetrix expression array full service Affymetrix expression array processing only Affymetrix SNP arrays Affymetrix DMET arrays Illumina expression array full service Illumina expression array processing only Illumina microRNA array Illumina whole genome SNP Illumina mouse low density SNP Illumina mouse medium density SNP Illumina custom SNP ABI 7900HT realtime PCR _ 96 well ABI 7900HT realtime PCR _ Micro fluidic card LC480 realtime PCR _ 96 well LC480 realtime PCR _ 384 well Microsatellite genotyping with 104 mouse markers Microsatellite genotyping with custom markers Lab-on-Chip Others _ please specify Quantity: Account Type: Rockefeller U. Non-RU Account Number (RU): Account Number (External): Comments:

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