Request
A Quote
All information provided in this form
is confidential.

Please fill out the entire form and click the "Submit" button at the bottom
of this page.

A Gentris representative will contact you after your on-line inquiry is received.

If you have any questions, please call Gentris at 919-465-0100
  Gentris Corporation Quotation and Sample Logistics Form
   
  * Required fields
   
  Your Company Name
  *
   
  Study Contact Information
Name *
Address *
Phone *
E-mail *
   
  How Did You Hear About Gentris?
 
   
  Protocol Number
  *
   
  Protocol Title
 
   
  Duration of Study
Start (mm-dd-yyyy format)
End (mm-dd-yyyy format)
   
 
Types of Services Requested
   
  Nucleic Acid Extraction
   
  DNA Extraction From Number of Subjects  
  Whole Blood  
  FFPE Tissue  
  Buccal Cells  
  Cell Lines  
  Buffy Coats  
  Tissue  
       
  RNA Extraction From Number of Subjects  
  Whole Blood  
  FFPE Tissue  
  Cell Lines  
  Buffy Coats  
  Tissue  
  Hair Follicles  
   
  Genotyping
   
  Genes to be tested Alleles (if known)  
  CYP2D6  
  CYP2C9  
  CYP2C19  
  UGT1A1  
  K-RAS  
  NAT2  
       
  Please list any other genes Alleles (if known)  
   
   
  Gene Expression
   
  Genes to be tested
  ACTB-CONTROL POLA  
  APEX1 RRM1  
  CDA SLC29A1  
  DCK TK1  
  DPD TP  
  ERCC1 TS  
  MLH1 UNG  
  OPRT XRCC1  
  PCNA XRCC5  
       
  Please list any others    
   
       
  Number of Subjects    
   
       
  Microarray Testing
       
  DNA Array    
  DMET™ Plus Premier Pack
  Genome-Wide Human SNP 5.0 Array
  Genome-Wide Human SNP 6.0 Array
   
  RNA Array
  GeneChip® Human Gene U133 Plus 2.0 Array
  GeneChip® Human Exon 1.0 ST Array
  GeneChip® Human Gene 1.0 ST Array
  GeneChip® miRNA Array
   
  Please list any others
 
   
  Number of Subjects
 
 
  Sample Banking
   
  DNA
  RNA
  PLASMA
  Serum
  Tissue
   
  Please list any others
 
   
  Duration (years)
 
   
   
  Turnaround Time
  Depending on turnaround time, additional fees may apply
  7-10 Business days (Standard TAT) 4 Business days
  6 Business days 3 Business days
  5 Business days 2 Business days
     
   
  Sample Submission Form (SSFs) and Lab Manual

(part of the patient confidentiality system and the chain of custody)
Yes No
   
  Return Shipping Kits

(Includes gel pack, all necessary packaging materials, IATA labels, preprinted FedEx return air waybill, Shipment Notification Form, FedEx Clinical Pack)
Yes No
   
  Collection Supplies
  (i.e. blood collection tubes and/or tissue collection supplies) required-type
  6 mL EDTA tubes
  10 mL EDTA tubes
  2 mL Cryovial
  PAXgene DNA tubes
  PAXgene RNA tubes
   
  Please list any others
   
  If Kits Are Required
  Dry Ice Shipping Kit Number of Kits Needed
  Gel Pack Shipping Kit Number of Kits Needed
       
    Number of Domestic Sites
    Number of International Sites
   
  Miscellaneous Comments (please provide any additional information)
 
 
 
 
 
 
 
 
   
 
   
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Gentris Corporation - 133 Southcenter Court Suite 400 - Morrisville, North Carolina 27560 - 919-465-0100 - PGx@gentris.com