If questions arise please provide us with:

Telephone number		Fax number
E-mail

I confirm that the recipient laboratory is permitted to work with genetically modified organisms (GmO) class I.

                                                                                           Signature ________________________________________

Please indicate whether you would prefer a courier shipment, which has to be paid by yourself:

if yes, please specify your Federal Express account number

For orders from European Union member states please specify the VAT identification number of your institution:

VAT number

Deviating invoice address (please skip if mailing and invoice address are identical):

Institution/Company
Department
Address (street, block number)
Post box (if required)
Postal zip code
City
Country/State

If you pay via Credit Card no administration fee becomes applicable. If Credit Card data are specified, please transfer the order form by fax only.

Visa

Mastercard

American Express

Cardholder name (in capitals) ___________________________________________________________

Card no. ________________________________________  CVV2 / CVC2 (security code) ___________  

Expiration date __________  Date _________________     Signature ____________________________

Ordered strains/plasmids (please specify the EUROSCARF accession number and the strain or ORF name to prevent any confusions)
 

accession number	gene / ORF name	strain / plasmid name