INDIVIDUAL ANIMAL SUBMISSION FORM (A)



Antibody Production Services (J)

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:      |State:    |City:      |

|Fax:(   )    -      |Phone:(   )    -      |Ext:      |

Services Requested:

General

Custom peptide synthesis

Antigen conjugation

Immunoassay (ELISA)

Immunohistochemistry

Gene Expression

Immunoblotting

Antibody production

Polyclonal antibody (use form E) – rabbit, goat, chicken

Monoclonal antibody

Hybridoma production (use form F)

Customized hybridoma optimization services (recloning, refusion, etc.)

Antibody purification

Custom ascites production

|Antigen:       |Molecular weight:       |Solubility:       |

|Conjugated? Yes No |If yes to what?       |

|Do you want us to conjugate the antigen? Yes No |

|To what? KLH BSA Other:      |

|Is antigen toxic? Yes No |Radioactive material? Yes No |

|Live pathogen? Yes No |Killed pathogen? Yes No |

|Host species: Rabbit Goat Chicken |

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