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Custom service requirements form
Products & Services
Services
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Supply Centre
Greener Product Alternatives
New Products
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(*Indicates a mandatory field)
Contact information:
First name
*
Last name
*
Organization
*
Department
Telephone
*
Email
*
Confirm email
*
Shipping address:
*
Billing address:
Nature of inquiry
*
Pricing estimate
Feasibility
Quote for grant proposal
Estimated order initiation
Immediately
1–2 Months
2–4 Months
>4 Months
Other
If "Other", please specify
Intended product use (
see questions below to determine intended use:
)
*
Research
Commercial
If you answer yes to any of the following questions, then the custom product will be considered a commercial-use product.
1
Do you plan, either now or in the future, to resell this product in any form?
2
Do you plan, either now or in the future, to use this product to manufacture a product that you will sell or use in a commercial service?
3
Do you plan, either now or in the future, to use this product in a commercial service, either under contract to a third party or on a fee-per-test basis?
Custom request:
Catalog number (if applicable)
Application for final deliverable
Product description
*
Quantity
*
Desired unit size (volume or mass)
*
Desired concentration
Preservatives
Buffer requirements
Additional details
