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 Low amount DNA

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 Low Amount DNA Conc.
(ng/uL)		 Total
Volume
(uL)		 Is the Required
QC
Documentation
Included?		 Specify
Sequencing Type
and # Cycles
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.