W.M. Keck Facility at Yale - Non-Yale Small Scale Peptide Synthesis Order Form

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NIDA Neuroproteomics Center

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W.M. Keck Facility
Yale University
300 George Street
Suite 201
New Haven, CT 06511

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Non-Yale Small Scale Peptide Synthesis Order Form

Your Last Name:		First Name:
PI's Last Name:		PI's First:
Institution::
Telephone:		Fax:
Email:
Billing Street Address:
City, State		Zip Code:

Shipping Street Address:
Building:		Room #:
City, State		Zip Code:

*Non-Yale Charging Instructions:*
P.O. Number HHMI

Enter a Purchase Order Number or a 6-digit HHMI Cost Center Number. Please indicate whether the charging instructions refer to a P.O. Number or HHMI above. If ordering by credit card, please Fax your order using the forms found HERE.

Peptide 1
*Scale*		*Purity*		*Amino Terminus*		*Carboxy Terminus*

	25 �M		Crude		Acetyl		Free COOH
	50 �M		Purified		Free NH₂		CONH₂
	100 �M				Other (Describe Below)

Enter Residues 1- 10 above. Separate with Dashes.
Enter Residues 11- 20 above. Separate with Dashes.
Enter Residues 21- 30 above. Separate with Dashes.
Any special instructions/unusual procedures, etc:

Peptide 2
*Scale*		*Purity*		*Amino Terminus*		*Carboxy Terminus*

	25 �M		Crude		Acetyl		Free COOH
	50 �M		Purified		Free NH₂		CONH₂
	100 �M				Other (Describe Below)

Enter Residues 1- 10 above. Separate with Dashes.
Enter Residues 11- 20 above. Separate with Dashes.
Enter Residues 21- 30 above. Separate with Dashes.
Any special instructions/unusual procedures, etc:

Peptide 3
*Scale*		*Purity*		*Amino Terminus*		*Carboxy Terminus*

	25 �M		Crude		Acetyl		Free COOH
	50 �M		Purified		Free NH₂		CONH₂
	100 �M				Other (Describe Below)

Enter Residues 1- 10 above. Separate with Dashes.
Enter Residues 11- 20 above. Separate with Dashes.
Enter Residues 21- 30 above. Separate with Dashes.
Any special instructions/unusual procedures, etc:

If you would like to order more than three peptides, place this order, click Back on your browser, change peptide information, and resubmit.


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