QC and Purification Sample Submission Form

Customer Information

First Name*
Last Name*
Institution*
Department*
Address*
Phone*
Email*
Date of Sample Submission*	12345678910111213141516171819202122232425262728293031 JanFebMarAprMayJunJulAugSepOctNovDec 2018201920202021202220232024202520262027202820292030203120322033203420352036203720382039204020412042204320442045204620472048204920502051205220532054205520562057205820592060206120622063206420652066206720682069207020712072207320742075207620772078207920802081208220832084208520862087208820892090209120922093209420952096209720982099
Are samples to be returned after project completion?*	-- Please Select --YesNo

Project Description

Name Your initials and amplicon i.e. KA_16S_sequencing
Sequencing project and quote number (if known)
What is the dollar value (AUD) of the samples being submitted?* For insurance reasons, please, provide sample valuation according to this document for valuation of samples

Sample Description

Sample type*	-- Please Select --gDNATotal RNAPCR ProductCustom Prepared Libraries
If sample type is Custom prepared library, please provide information on the type of library. Refer to the sample submission guide.
Sample taxa*
Extraction method*
Elution buffer*
Service* **The concentration of all samples need be in a similar range. In case of a failure of a kit due to some too low or high concentrated samples, the measurement will be repeated using an appropriate kit and extra costs will be charged. (Available kits: TapeStation: DNA D1000, DNA High Sensitivity D1000, Genomic DNA, RNA; BioAnalyser chips: RNA Nano, RNA Pico, DNA)	TapeStation/BioAnalyser** LabChip Covaris
Sample submission sheet (.xls or .xlsx)* Please see attached sample info sheet.
Additional comments or special notes?
I will acknowledge the WSU NGS facility in any publication or presentations where this data is used*	YesNo