Immunogen Form for Polyclonal Antibody Production

Antigen Name: *

Antibody to be raised in: *

Amount (Please provide minimum 3-5 mg of protein): *

Volume: *

Buffer: *

Concentration: *

Number of vials sent: *

Is antigen conjugated?: *

Yes

No

Immunogen conjugated to carrier protein?

Immunogen conjugated to carrier protein?: *

Not Conjugated

KLH

BSA

BGG

Other (specify):

Biohazard concerns: *

Other concerns or instructions: *

Antigen state: *

Antigen storage: *

Antigen size/ Mol. Wt: *

Immunogen isolated or based on sequence from what species?

Immunogen isolated or based on sequence from what species?: *

Human

Mouse

Rat

Yeast

Other (specify):

Immunogen Physical Form

Immunogen form (mark with left)	Amino Acid Positions (optional)	Description

Peptide

Recombinant Protein

Tagged Fusion Protein

Other Fusion Protein

Purified Native Protein(or fragment)

Others

Data to indicate immunogen integrity (for recombinant protein only): *

Please include a Coomassie Blue stained gel picture: *

Purification: *

Yes

No

Protein-G

Peptide Affinity

Customer Contact details

Name: *

Organization: *

Dept: *

Email: *

Phone number: *

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Immunogen Form for Polyclonal Antibody Production