Peptide Antigen for Antibody Production Order Form — UNC High-Throughput Peptide Synthesis and Array Facility

E-mail of Person Placing Order

Name of Person Placing Order (Last name, First)

Phone of Person Placing Order Example: 9199621058 (include area code and exclude all symbols)

Name of UNC Investigator (confirms affiliation) (Last name, First)

PEPTIDE SEQUENCE (Enter the peptide to be sequenced - use nomenclature guide as a reference for modifications)

Cysteine Position

N-terminal Cys
C-terminal Cys

N-terminal (Other) (Example: Biotin)

N-terminal

NH2
Acetyl
Other (please enter in below)

C-terminal

COOH
CONH2
Other (please enter in below)

C-terminal (Other)

Synthesis Scale

10 mg (suggested amount)
Other (please entire in below)

Synthesis Scale (Other)

Requested Completion Date

Year / Month / Day