Inquiry Format for Next Generation Sequencing

Inquiry(required)

Name(required)

Affiliation(required)

E-mail(required)

E-mail (for confirmation)(required)

TEL

FAX

Address

Customer Code

　

Personal Information(required)
Your provided personal information will be strictly protected to be used only for improving our product/service, answering to inquiries, sending direct mails and other related services.
Please have a look through the "Privacy Policy" page and send us a form.
　
Confirmation(required)
Please make sure to confirm the above information correct once again before clicking the below "Send" button as no confirmation screen will be shown afterwards. *Printing out this page is recommended before sending.

F08625 23/08/10 Rev.2

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