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GENOTYPING SERVICES (S) Please print and complete this form and forward/fax to MDS. We will contact you for a detailed quotation. Institution: Investigator: Email: Billing Address: Submitted by: Date Submitted: / / PO #: Shipping Address: Zip: Fax:( State: ) - Phone:( City: ) - Ext: Services Requested: Chromosome Enumeration Karyotyping FISH Services Cell Line Characterization Sex Determination Isoenzyme profiles DNA Fingerprinting Isoenzyme Analysis Cell Line Identity Verification Fluorescent antibody staining Authentication Services Intraspecies cross-contamination verification DNA fingerprinting STR SNP Microarrays Please provide us with an overview of your project: Cell Line Info Species Sex Age Passage Characteristics Growth Medium Doubling Time Name Probe Species: Human Mouse Rat Others: Name: Vector Insert Size: kb Insertion Site: (eg: EcoRI/Xbal) DNA concentraion: ~ 1.0 ug/ul Human Chromosome Mapping on: Mouse Chromosome Specific Cell Line Tg mouse chromosome Other: Additional photo: sets Presentation slide: sets