INTENDED USE FORM Who We Are Who We Serve Our Quality Control Process FAQs Our Products Ask a Question How to Order To expedite processing of your order, please complete entire form. Please enable JavaScript in your browser to complete this form.Company Name *Business Type (check all that apply) *BiotechGovernmentHospitalPharmaceuticalResellerOtherUniversityEnd User Name *FirstLastEnd User Title/Department *End User Phone Number *End User Email Address *Billing Address *Shipping Address *Purchaser Name *FirstLastPurchaser Title *Purchaser Phone Number *Purchaser Email Address *Catalog No. *Product Description *Quantity for Immediate Purchase *Quantity Per Year *Number of Years *Intended Use *Will your company make a profit from the use of this product or any of its progeny? *YesNoIf your intended use is research, what is the source of your funding?Will the results of your research go through your Technology Transfer Office? *YesNoN/AWill your research be published? *YesNoWhat is the expected time frame of your project? *1 year2 years3 years4 years5+ yearsWill the product be used for validation, verification, or to perform a service? *ValidationVerificationServiceOtherWill the product or any of its progeny be used as a control for paid tests? *YesNoSubmit