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LSS form

We would appreciate if you could complete the following questionnaire to ensure that the reagent you are requesting for your customer is our best suited reagent for his/her application.

Customer contact details

First Name *

Last Name *

Company / Institution *

Job Title

Department

Street Address *

Zip / Postal Code *

City *

Country *

State *

If applicable (USA & Canada)

Phone *

Email *

LSS Email *

Sales Rep Email

Other sales rep email

About requested sample

Transfection reagent currently used? *

Which reagent would you like to test? *

Type of molecule to transfect? *

What is your customer's application? *

Antibody and Protein production

Cell & Gene Therapy

Drug Discovery

DNA/RNA therapeutics

Diagnostic

Fundamental Research

Other

Routinely used plate format

Transfected plates per month

Cell(s) to transfect? (starting with the most important): *

Comments:

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