Flow Cytometry Service Request

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P.I.

Contact Person		Ordered:
Location
Phone
Email		Fax
Comments
Comments

Analysis ServiceSorting Service
I'd like to request time on this date: Check Availability on Google Calendar
Time of day (eg "1pm-4pm"):
Total number of hours and Minutes:	Hours	Minutes
The date and time requested is:

Please Note: Price based on PI memberships above. We will contact you for time and exact cost.

= 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

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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