EG Project ID: Date Received: Date Completed:
Invoice Number: PM: Technician:
PO Number: PO Issued on: PO Amount:
Quote Number: Quote Issued on: Quote Amount:

Eureka Genomics Sample Submission Form for a Prepared Library

Completed forms must be included with the sample shipment and sent by email via the submission button below. Samples lacking a completed form will be
delayed and/or refused.

Required fields are bold

Step 1. General Information

Customer Contact Information

Name:
Institution:
Department:
Building/Room:
PO Box:
Street Address:
City:
State:
Zip:
Country:
Phone:
E-mail:
Principal Investigator:

Accounting Billing Information

Name:
Institution:
Department:
PO Box:
Street Address:
City:
State:
Zip:
Country:
Phone:
E-mail:

Step 2 . Sample Information

A: Is the sequence data to be used in a Eureka Genomics project for Next Generation Sequence Analysis? Yes No

Step 3: List of Samples

Sample Description Sample ID
as appears
on tube		 Type of Prepared Library DNA insert only
size (bp) for
Paired End
Library		 Conc.
(ng/uL)		 Total Volume
(uL)		 Is the Required
QC
Documentation
Included?		 Specify
Sequencing Type
and # Cycles		 Minimum Amt
of Data
Requested
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.

For Shipping and Handling Information, Click Here.

Sample requirements and documentation for submission

Access code:
Please enter the word "EGcode" in the space above to submit form.