Immune Monitoring Service Request Form

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P.I.	You must select a P.I. for this order. Choose your P.I.'s name from the list on the right to select.
Contact Person
Location
Phone
Email		Fax
Comments
Comments

*Cancer Center members receive a 20% price discount below listed prices.

Service	Cost	Quantity
Apheresis cell processing and cryopreservation	$400
Blood tube PBMC processing - each additional tube	$10
Blood tube PBMC processing - first tube	$65
Consultation/Tech Support (per hour)	$60
Custom Cytokine Multiplex Kit	Call
Cytotoxicity/ chromium release (per plate)	$300
ELISPOT Analysis Self-Service (per hour)	$15
ELISPOT Analysis Training (including 3hrs reader use)	$180
ELISPOT Assay (per plate)	$750
ELISPOT Assay custom peptide pools	Call
ELISPOT Color Prints (per page)	$1
FACS Analysis (per hour)	$75
HPV Typing - each additional sample	$250
HPV Typing - First sample	$1000
Intracellular cytokine staining ( up to 36 samples, antibodies not included)	$300
Multiplex cytokine analysis (plate reading - per hour)	$50
Proliferation assay (per plate)	$400
Sample storage (per vial or specimen for 6 mo.)	$1
Serum/Plasma tube processing	$10
TCR V alpha spectrotype - human (per sample)	$500
TCR V alpha spectrotype - mouse (per sample)	$450
TCR V beta spectrotype - human (per sample)	$550
TCR V beta spectrotype - mouse (per sample)	$450
Tetramer analysis (up to 36 samples, reagents not included)	$300
Tetramer Included	Call

Cancer Center Member Discount: $-

= 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)

Anantomical 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)
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