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GENETIKA MOLECULAR SERVICES

HUMAN gDNA EXTRACTION ORDER FORM

CUSTOMER DETAILS
Name
Ref ID
Institute name/department
Address
Contact number (office) : (mobile) :
Email address

TYPE OF SERVICE SAMPLE SUBMISSION ADD-ON SERVICE


(please tick one [ ] ) (please tick one [ ] ) (Separate charges will apply)
EDTA tube
Blood gDNA miniprep PCR Optimization
FTA Card
Saliva gDNA miniprep Saliva collection tube PCR Optimization

SAMPLE INFORMATION
No. Sample name (as indicated on the tubes)

Total number of sample


# If you have large number of samples, please attach a separate sheet with the details as requested in the above table

Additional informations :

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