Website: cgs.hku.hkContact Person: Mandy Tang / Tsztung Ng / Wystan Zeng / Rachel LiEmail: sangerseq.cgs@hku.hkContact No: 2831-5477 / 2831-5467Order No.: GA- ______________________________________

Genetic Analysis Service Request Form

User InformationP.I. Email:

User Name:P.I. Name: Project Name/ID:

User Email:

Billing Address:- - - - -

Department:

User Contact No.: Fax:

Signature:

Billing Account:

Sample Submission Date (yyyy-mm-dd):

Type of Services

ABI BigDye v3.1

Reaction, Purification & Run (in 15µL) (Qty:________________)

Full service:

Purification & Run (in 20µL) (Qty:________________)

* Protect cycle sequencing products from light

Sample Information

Source of genomic DNA: Plasmid PCR Product

Others:_________________________

Sample Storage: RT 4°C -20°C -80°C

Biohazard Samples: Yes No

Note

* Refer to CGS website (cgs.hku.hk) for CGS Primer Sequence and other detailed submission information - All colored samples are unacceptable - We DO NOT accept any sample with potential biohazard - We DO NOT recommend samples with coloured dye

- Use appropriate vessels for sample submission: Sample # 1 - 7 : 0.2 mL microtubes # 8 - 32 : 8-well strip tubes # 33 - 90 : 96-well plate (leave 6 empty wells for run controls) (place samples in the order of A1-H1 ->A2-H2 and so on)

- Label and print clearly (unclear information will cause delayed processing) - Submit all samples in a plastic bag with clear identification information - For Research Use Only. Not for use in diagnostic procedures - For personal data protection, please be reminded that the submitted sample IDsshould NOT carry any personal information such as the HKID or passport numbers, thelaboratory numbers of patient reports, or the patient IDs of hospitals.- Please refer to the Privacy and Personal Data Protection Policies at http://cgs.hku.hk/portal/index.php/policies for information on personal data protection and handling byCGS.

Fill in ALL information below:

Sample Name (Max. 8 characters on hardcopy)

(No SPACE within name)

Expectedread length

(bp)

1

2

3

4

5

6

7

8

For more than 8 samples, submit "Sample Information File". Spreadsheettemplate available online from CGS website (cgs.hku.hk). Submit ahardcopy as well as email the file to sangerseq.cgs@hku.hk.

Sign Date Remarks

Courier Collection box at FMB / QM / SBS

Gel photo(s) Sample list (hardcopy) Sample list (email)

Sample received by :For Official Use

Sign Date RemarksSample Tracking

Result Delivery

Database input

Additional Remarks:

Result Delivery - rerun

Sequencing Purification

Sequencing ReactionNotify user sample received

Run - Plate ID:

Rerun Plate ID

100-200 bp

200-500 bp500-1000 bp

1000-2000 bp

>2000 bp

PCRProduct

2000 - 3000Bacterial genomic DNA

DNA Amount (ng)

20 - 50

3 - 10

10 - 40

1 - 3

500 - 1000Cosmid, BAC

150 - 300ds DNA, plasmid

5 - 20

25 - 50ss DNA

Top up to 14uL with water (DNase free)Add 1ul of 5uM sequencing primer

Unit price

Payment (For Official Use)

Qty Sub total (HK$)Service Options

Total:

QA/QC Supervisor: Date:

Date:Job done by:

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