Bioreagent & Cell Culture Core Service Request Form

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P.I.
Contact Person		Ordered:
Location
Phone
Email		Fax
Comments
Comments

Service	Price ($)	Quantity

Grow cell in large quantity	Call
Monoclonal Antibody production	Call
Mycoplasma test	40.00
Fetal Bovine Serum 500ml (>= 10 bottles $149)	169.00
Fetal Bovine Serum, Charcoal treated (500mL)	290.00
Fetal Bovine Serum, Dialysed (500mL)	Call
Bovine Calf Serum(500mL)	40.00

= Estimated Total $

Billing
If outside USC, you may use a PO, including CHLA and Doheney Inst.

Payment Method:

USC Account Number
Purchase Order (PO)
Account will be provided later
Credit Card

USC Account # or PO:

Organization

(optional)

Grant #

(optional)

Anatomical Site

Human Stem Cell research?

YesNo Under penalty of law, please honestly indicate if this order is for non-Federally approved Human Stem Cell research? Federal regulations require these projects not be subsidized by federal funds. If yes, additional costs may apply.

Invoice Mailing Address (POs)
Enter Address
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*To copy order completed emails to your PI/Lab Manager, contact us.