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OLIGO SUBMISSION FORM ORDER INFORMATION BILLING INFORMATION My name: Bill to: Company: Address 1: Address 1: Address 2: Address 2: PO: Tel: E-mail: Fax: ID Primer Seq(5'to3') Base Pack (OD/Vial) Qty.(OD) QTY(nmole) Purification Unit Price Labeling ID Do not enter, for internal use only Primer One oligo, one unique name Seq(5'to3') Enter capital letters, and do not enter space or other symbols Pack Enter the number of vials per oligo

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