| FAX ORDER FORM | DATE:______________ |
| TARGETING SYSTEMS 1453 N. Cuyamaca St. El Cajon, CA 92020 |
TEL (619) 562-1518 FAX (619) 562-1326 |
Fill in form completely and fax to (619) 562-1326 or email to targsys@aol.com
| Billing Name | _______________________________________________________ | |
| Company Organization/Name | _______________________________________________________ | |
| Mailing address for business or correspondence | ________________________________________________________________
________________________________________________________________ ________________________________________________________________ |
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| City, State, Zip | ________________________________________________________________ | |
| Country_______________________ | Phone # ________________________ | FAX______________________ |
| Purchase Order#_______________ | End user name __________________ | Phone #__________________ |
| Credit card (circle one) | VISA | MASTERCARD | AMEX |
| CREDIT CARD NUMBER | |||
| EXPIRATION DATE Month_____________ Year _______________ Vcode _____________ Billing Zip code ___________________ | |||
| NAME ON CARD | CONTACT PHONE | ||
| CIRCLE ITEMS REQUESTED | |||
| QTY | Cat Number | Description | Price (each) |
| #001 | Targefect F-1 (0.5 ml, 1mg) | $115.00 | |
| #002 | Targefect F-1 (4x 0.5ml) | $420.00 | |
| #003 | Targefect F-2 (0.5 ml) | $115.00 | |
| #004 | Targefect F-1 (4x 0.5 ml) | $420.00 | |
| #007 | Virofect Enhancer (600ul) | $100.00 | |
| #008 | Peptide Enhancer (0.5ml) | $100.00 | |
| #0041 | Profect - P1 (0.25ml / 50 reactions) | $150.00 | |
| #0042 | Profect - P2 (0.25ml / 50 reactions) | $150.00 | |
| #0043 | Profect - P1 (3x0.25ml / 150 reactions) | $350.00 | |
| #0044 | Profect - P2 (3x0.25ml / 150 reactions) | $350.00 | |
| #0060 | Targefect siRNA Transfection Kit (100 reactions) | $200.00 | |
| #0070 | pCMV-Gluc-1 (25ug) | $420.00 | |
| #0071 | pGluc-Basic (25ug) | $420.00 | |
| #0072 | Gaussia luciferase assay kit (1000 assays) | $350.00 | |
| #0075 | Gaussia luciferase assay system: pCMV-Gluc, pGluc-basic(25ug each) plus luciferase assay kit(25 reactions) | $750.00 | |
| #0081 | pCMV-Gluc-kdel |
$420.00 | |
| #0082 | pCMV-Basic-kdel |
$420.00 | |
| #0085 | Gaussia luciferase assay system: pCMV-Gluc-kdel, pGluc-basic-kdel(25ug each) plus luciferase assay kit(25reactions) | $750.00 | |
| #293-01 | Targefect-293 (1ml) | $170.00 | |
| #293-10 | Targefect-293 (10x1ml) | $1600.00 | |
| #SMC-01 | Targefect-SMC (100 reactions) | $250.00 | |
| #SMC-10 | Targefect-SMC (10x100 reactions) | $2000.00 | |
| #BAC-01 | Targefect-BAC (100 reactions) | $250.00 | |
| #BAC-10 | Targefect-BAC (10x100 reactions) | $2000.00 | |
| #HEP-01 | Targefect-Hepatocyte (200 reactions) | $250.00 | |
| #HEP-10 | Targefect-Hepatocyte (10x200 reactions) | $2000.00 | |
| #HUVEC-01 | Targefect-HUVEC (100 reactions) | $300.00 | |
| #HUVEC-10 | Targefect-HUVEC (10x100 reactions) | $2500.00 | |
| #COS-01 | Targefect-COS (1ml) | $160.00 | |
| #COS-10 | Targefect-COS (10x1ml) | $1250.00 | |
| #RAW-01 | Targefect-RAW (1ml) | $170.00 | |
| #RAW-10 | Targefect-RAW (10x1ml) | $1600.00 | |
| #Hela-01 | Targefect-Hela (1ml) | $170.00 | |
| #Hela-10 | Targefect-Hela (10x1ml) | $1600.00 | |
| #MEF-01 | Targefect-MEF (1ml) | $250.00 | |
| #MEF-10 | Targefect-MEF (10x1ml) | $2000.00 | |
Ship To Address (if different from above): Tax and Shipping costs will be added to order
| Attention | |
| Company / Organization Name | |
| Street Address | |
| City, State, Zip Code, Country |