Shipping Address:

Davis Sequencing
1490 Drew Avenue, Suite 170
Davis, CA 95616
Phone: (530) 297-5038
Fax: (530) 297-5039
U.S. University Printable Request Form
Name: _____________________________ Date: _______________________________
E-mail: _____________________________ Phone: _______________________________
Lab PI Name: _____________________________ P.O. #: _______________________________
Department:  _____________________________  Note: all requests require a P.O. # or credit card #
Credit Card #:
(w/ expiration date)		 _____________________________  Credit Card Holder's Name: __________________
(please print clearly)
How do you want your sequences sent (circle one)? E-mail, Zip Disk, or Floppy Disk*
*Please include a blank zip disk or floppy disk (1 disk/7 sequences) with your DNA sample shipment.
date order received:________ drop off box #:________ date work completed:________
Reaction #
 DNA Template ID #
(first, middle, & last initials
followed by #)
Sequencing Primer
Tm if PCR primer
and Concentration
DNA Template Source
(ds plasmid, ss, PCR product, etc.)
and Purification Method		 Size and Concentration
Example
DLN-1
m13 (-21) (3 µM)
ds plasmid
Qiagen purified
4 kb 200 ng/µL
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