Genome Service Request Form

1. Customer Information

Provide the primary contact responsible for the submission.

Organization

Department

Contact name

Email

Telephone

Customer or account number

Billing address

Purchase order number

Quote number

2. Requested Services

Select all services that may apply. The final strategy, scope, and acceptance criteria are confirmed during technical review.

Current project stage

Requested turnaround

Project objective

Proposed success or acceptance criteria

3. Cell Line and Editing Project Information

Add one project record for each cell line, target, or distinct edit.

4. Materials, Shipping, and Deliverables

Complete shipping fields only when customer-supplied materials will be transferred.

Planned shipment date

Carrier

Tracking number

Shipping condition

Customer-supplied material

Return remaining customer material

Shipping or handling notes

Deliverable format, clone quantity, or other requirements

5. Customer Authorization

The submitting customer must review and accept the statements below.

I certify that the information is accurate and the materials are authorized for research gene-editing work.I certify that the submission contains no direct patient identifiers.I have disclosed all known biological hazards, infectious agents, recombinant materials, and special handling requirements.I understand that this request is for research use only and not for clinical diagnosis, patient treatment, or human germline modification.

Authorized name

Title

Date

Electronic signature

6. B&B Bio Use Only

Project number

Request received

Reviewed by

Technical feasibility

Estimated timeline

Project status

Laboratory notes

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Gene Editing (CRISPR) Service Request

Gene Editing Service Request Form

1. Customer Information

2. Requested Services

3. Cell Line and Editing Project Information

4. Materials, Shipping, and Deliverables

5. Customer Authorization

6. B&B Bio Use Only

Editing Project

Human Cell-Line Model

Target and Intended Edit

Editing Strategy and Endpoint