Peptide order form : Peptide synthesis , Peptide Production ,Peptide Sequence ,Multiple Antigenic Peptide(MAP) System ,Protein Carrier Conjugation,Fluorescence/Dye labeling

1. Peptide Order Form
4150 Tuller Rd, Suite 228
Dublin, Ohio 43017
Fax: 614-792-8685
Phone: 614-792-8680
Toll Free: 800-860-9729
e-mail: save@bio-world.com l abor at or y ser -
w w w . bi o- w or l d. c om
Please fill out form as completely as possible.
BILL TO: PO#________________ Customer#________ SHIP TO:
Name_________________________________________ Name_______________________________________
Institution______________________________________ Institution____________________________________
Department_____________________________________ Department__________________________________
Address________________________________________ Address_____________________________________
______________________________________________ City, State, Zip________________________________
City, State, Zip__________________________________ Phone_______________________________________
Phone_________________________________________ Fax_________________________________________
PEPTIDE 1 Peptide Name__________________________ Write Sequence N to C INDEX
A-Ala
___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 C-Cys
d-Asp
e-Glu
___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___
26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 F-Phe
g-Gly
Purification __Unpurified (15-40mg) __>70%pure (5-25mg) __>80%pure (5-15mg) __>95%pure (5-10mg) H-His
I-Ile
Conjugation __KLH (Keyhole Limpet Hemocyanin) __BSA(Bovine Serum Albumin)
K-Lys
Conjugation Terminal End __ N-terminal __C-terminal L-Leu
M-Met
Modifications___________________________________________________________________________________________________
N-Asn
______________________________________________________________________________________________________________ P-Pro
Q-Gln
____________________________________________________________________ Setup (MAPONLY) $__________
R-Arg
AA Bases ≤80# ___ $__________
Comments___________________________________________________________ S-Ser
AA Bases >80# ___ $__________
T-Thr
____________________________________________________________________ Modifications $__________
V-Val
____________________________________________________________________
Purification $__________
W-Trp
TOTAL $__________ Y-Tyr
Modification Succinylation $60.00 Multiple Antigenic Peptide (MAP) System
Acetylation $65.50 Sulfonation $485.00 Set-Up Fee (ALL MAPPEPTIDES) $75.00
Amidation(C-terminal) $50.00 Fluorescence/Dye labeling Asymmetric 4 branches $275.00
Benzyloxycarbonylation $48.00 Aminocoumarin $200.00 Symmetric 4 branches $285.00
Biotin $150.00 Biodipy $350.00 Asymmetric 8 branches $295.00
Dansylation $60.00 Fluorescein $200.00 Symmetric 8 branches $295.00
Dinitrobenzoylation(DNP) $60.00 Lissamine $250.00
Fatty Acid $48.00 Rhodamine $195.00 Purification
Formylation $160.00 NBD $250.00 Unpurified (Greater than 60% Pure) $0.00
Nitronation $120.00 Tetramethylrhodamine $200.00 Greater than 70% Pure $170.00
Phosphorylation-Serine $160.00 Protein Carrier Conjugation Greater than 80% Pure $210.00
Phosphorylation-Threonine $160.00 KLH(Keyhole Limpet Hemocyanin $245.00 Greater than 95% Pure $260.00
Phosphorylation-Tyrosine $160.00 BSA(Bovine Serum Albumin) $245.00
ORDERING AND CREDIT CARD INFORMATION ___VISA ___Mastercard
Amount $__________ + Shipping $____________= TOTAL $____________
Card Number_______________________________________ Expiration Date__________
Cardholder Name (as it appears on card) _________________________ Signature__________________________________________

2. Peptide Order Form continued Use this form for additional peptide sequences.
I A-Ala F-Phe K-Lys P-Pro T-Thr I
N C-Cys g-Gly L-Leu Q-Gln V-Val N
D D
d-Asp H-His M-Met R-Arg W-Trp
E E lab or at ory se r -
X e-Glu I-Ile N-Asn S-Ser Y-Tyr X w w w.bio-
PEPTIDE 2 Peptide Name__________________________ Write Sequence N to C
___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25
___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___
26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50
Purification __Unpurified (15-40mg) __>70%pure (5-25mg) __>80%pure (5-15mg) __>95%pure (5-10mg)
Conjugation __KLH (Keyhole Limpet Hemocyanin) __BSA (Bovine Serum Albumin)
Conjugation Terminal End __ N-terminal __C-terminal
Modifications/Comments:_________________________________________________________________________________________
______________________________________________________________________________________________________________
______________________________________________________________________________________________________________
PEPTIDE 3 Peptide Name__________________________ Write Sequence N to C
___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25
___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___
26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50
Purification __Unpurified (15-40mg) __>70%pure (5-25mg) __>80%pure (5-15mg) __>95%pure (5-10mg)
Conjugation __KLH (Keyhole Limpet Hemocyanin) __BSA (Bovine Serum Albumin)
Conjugation Terminal End __ N-terminal __C-terminal
Modifications/Comments:_________________________________________________________________________________________
______________________________________________________________________________________________________________
______________________________________________________________________________________________________________
PEPTIDE 4 Peptide Name__________________________ Write Sequence N to C
___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25
___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___
26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50
Purification __Unpurified (15-40mg) __>70%pure (5-25mg) __>80%pure (5-15mg) __>95%pure (5-10mg)
Conjugation __KLH (Keyhole Limpet Hemocyanin) __BSA (Bovine Serum Albumin)
Conjugation Terminal End __ N-terminal __C-terminal
Modifications/Comments:_________________________________________________________________________________________
______________________________________________________________________________________________________________
______________________________________________________________________________________________________________
4150 Tuller Rd, Suite 228 • Dublin, Ohio 43017 • Phone: 614-792-8680 • Toll Free: 800-860-9729 • Fax: 614-792-8685 • save@bio-world.com