Peptide Online Order

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Copyright 2006. All rights reserved. Antagene Inc.
2245 Fortune Drive, Suite C,
San Jose ,CA95131
Tel 1 (866)964-2589 l Fax (650)964-2519 l info@antageneinc.com
Contact webmaster

Contact Name:

Institute:

Shipping Address:

Phone:

E-mail:

Fax:

P.O.#:

Card Type:

Cardholder's Name:

Exp. Date:

Billing Address:

or

City, State, Zip:

City, State, Zip:

Types:

Peptide

Sequence name:

Length:

Peptide scale of
synthesis:

Amount needed:

Purification code:

Modification:

Labeling:

Conjugation:

Sequence #1

Peptide
Sequence:
NH₂ to COOH

OR complete another sequence below

If other scale, Please call 650-964-2589

Credit Card #:

Sequence #2

Types:

Peptide

Sequence name:

Length:

Peptide scale of
synthesis:

Amount needed:

If other scale, Please call 650-964-2589

Purification code:

Modification:

Labeling:

Conjugation:

Peptide
Sequence:
NH₂ to COOH

Other Code #:

Other Code #:

This online order form can order two sequences at a time. Large orders can be completed by sending information on multiple forms. If there's a problem with this form, you may send the information by E-mail to Sales@antageneinc.com or call 1-650-964-2589.

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Antagene, Inc.
Toll Free: 1 (866) 964-2589
Fax (650) 964-2519
info@antageneinc.com