Online Order Form

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Use this form to order up to five sequences. Large orders can be completed by sending information on multiple forms. If you have any problems with this form, you may send the information by E-mail to order@genemedsyn.com or call 1-800-344-5337.

Your Name: 

 

Company: 

 

Shipping Address:

 

City, State, Zip:

 

Telephone: 

 

(Required)

Fax:

 

E-mail:

 

Billing Address:

 

City, State, Zip:

 

Payment Method:

 

P.O.# or Credit Card Number:

 

Expiration Date:

 

Others if any

 

 

 

Antibody #1

Antibody Types:

  Peptide    

or

Protein 

 

If it is peptide antibody, please fill the following information. 

 

Sequence name:

 

Length:

 

 

Peptide scale 
of synthesis:

 

Other scale:

If other scale, Please call 800-344-5337

 

Purification code:

Crude, >80% or 90%

 

Modifications:

Phosphorylation or others

 

Conjugation:

KLH, BSA or others

 

Others:

 

 

 

 (Peptide codes)

 (AA Codes)

 

 

Peptide
Sequence:
NH2 to COOH 



Type:

      Antibody

 

 

Antibody Name:

 

 

Antibody 
Type:

 

 

Complete Service:

Yes or you provide antigen

 

Affinity Purification:

Yes or no

 

ELISA Test:

Yes or no

 

Phospho-
Antibody:

Yes or no

 

Additional
Items:

(Antibody Items)

 

 

Other Notes or Requirement:




OR complete another sequence below.

Antibody #2

Antibody Types:

  Peptide    

or

Protein 

 

If it is peptide antibody, please fill the following information. 

 

Sequence name:

Length:

 

 

Peptide scale 
of synthesis:

 

Other scale:

Please call 800-344-5337

 

Purification code:

 (Peptide codes)

 

Modifications:

 (AA Codes)

 

Conjugation:

 

 

Others:

 

 

 

 

 

 

 

Peptide
Sequence:
NH2 to COOH 



Type:

Antibody

 

 

Antibody Name:

 

 

Antibody 
Type:

 

 

Complete Service:

(Antibody Items)

 

Affinity Purification:

 

 

ELISA Test:

 

 

Phospho-
Antibody:

 

 

Additional
Items:

(Antibody Items)

 

 

Other Notes or Requirement:



 


OR complete another sequence below.

Antibody #3

Antibody Types:

  Peptide    

or

Protein 

 

If it is peptide antibody, please fill the following information. 

 

Sequence name:

Length:

 

 

Peptide scale 
of synthesis:

 

Other scale:

Please call 800-344-5337

 

Purification code:

 (Peptide codes)

 

Modifications:

 (AA Codes)

 

Conjugation:

 

 

Others:

 

 

 

 

 

 

 

Peptide
Sequence:
NH2 to COOH 



Type:

Antibody

 

 

Antibody Name:

 

 

Antibody 
Type:

 

 

Complete Service:

(Antibody Items)

 

Affinity Purification:

 

 

ELISA Test:

 

 

Phospho-
Antibody:

 

 

Additional
Items:

(Antibody Items)

 

 

Other Notes or Requirement:



 


Genemed Synthesis Inc.
Complete our on-line order form

6203 Woodlake Center Dr. Bldg 2

San Antonio, TX 78244 USA
E-mail: info@genemedsyn.com Toll-free: 1-800-344-5337
Phone: 210-745-5988 Fax: 210-745-5992
Web Site: http://www.genemedsyn.com

Genemed Synthesis Inc

Please note our Address has changed!!!