External Account Sample Submission Form

Billing

Accountant Name*

Accountant Email*

Organization*

Department*

Billing Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Please indicate one of the following for payment for services:

PO#

*attach PO copy below

PO Copy

Max. file size: 98 MB.

Check #

Date Check Was Sent

Preferred Shipment Date*

HTSF will confirm available dates

Preferred Data Delivery Deadline (HTSF will confirm)*

Study Shipping Site Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

# of Samples to be Shipped*

Method of Shipment*

Miseq	Novaseq -SP
Miseq Nano	Novaseq-S1
HiSeq 2500 Rapid Run	Novaseq-S2
HiSeq 2500-v4 High Output	Novaseq-S4
Hiseq 4000
*XP Kits available for all NOVASEQ options (allows single lane per pool to be run)