Submitted by___________________________   Date Submitted_____________________________

Lab P.I._______________________________  Number of Samples Submitted_________________

Lab Address___________________________   Species of Samples__________________________

Email_________________________________   Phone Number_____________________________

____________________________________________________________________

Template Name            Primer Name    Insert Size    Vector         Template Type   Concentration

(Max. 6 char.)                  (4µM)               bp                             (PCR, BAC, etc)     (ng / µL)

1__________________ _______________ ___________ _____________ _______________ _______________

2__________________ _______________ ___________ _____________ _______________ _______________

3__________________ _______________ ___________ _____________ _______________ _______________

4__________________ _______________ ___________ _____________ _______________ _______________

5__________________ _______________ ___________ _____________ _______________ _______________

6__________________ _______________ ___________ _____________ _______________ _______________

7__________________ _______________ ___________ _____________ _______________ _______________

8__________________ _______________ ___________ _____________ _______________ _______________

9__________________ _______________ ___________ _____________ _______________ _______________

10_________________ _______________ ___________ _____________ _______________ _______________

11_________________ _______________ ___________ _____________ _______________ _______________

12_________________ _______________ ___________ _____________ _______________ _______________

To indicate a priority in sequencing, please add a star (*) next to the template name.

Methods of sample preparation and purification________________________________________

____________________________________________________________________________

Sequences will be named as follows: Researcher’s initials-template name-primer name

All tubes must be clearly labeled with the same names as entered on this form.