CleanAmp™ dNTPs Order Form

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CleanAmp™ dNTPs Order Form^{___________________________________________________________}

PRODUCT INFORMATION (* Indicates Required Field)
If you are interested in bulk quantities, please email sales@trilinkbiotech.com for a quotation.

CleanAmp™ dNTP Mix
dATP, dCTP, dGTP, dTTP at 10mM

Catalog #	Pack Size	Price
N-9501-2	2 µmole each (4 x 2)	$90
N-9501-10	10 µmole each (4 x 10)	$350

	Quantity

CONTACT INFORMATION

PAYMENT METHOD

*Full Name

Promo Code

*Phone

PO Number

*Email

Credit Card Type

Name on the Card

Credit Card Number

Expiration (MM/YYYY)

BILLING ADDRESS

SHIPPING ADDRESS
(leave blank if same as billing)

*Institution

Institution

*Name

Name

*Address 1

Address 1

Address 2

*City

City

*State or Province

State or Province

*Zip or Postal Code

Zip or Postal Code

*Country

Country

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