Request form for Peptide Synthesis

University of Kansas
Biochemical Research Service Laboratory

REQUEST FORM FOR PEPTIDE SYNTHESIS

BRSL # ____________________

Date: ___________________ Name: ___________________________________________________

Department: _______________________________ Address: ________________________________

Phone: ___________________________________ E-mail: _________________________________

P. I. Signature: ______________________________ Account # _____________________________

Sequence desired: H₂N-___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___

___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ -COOH

Amount required:
[ ] 5-20 mg
[ ] 20-50 mg
[ ] 50-120 mg
Purify final product?
[ ] No
[ ] Yes, if yes, what purity you need
[ ] 90 %
[ ] 95%
[ ] >95%
Special instructions: ________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________