For internal use only:

CUSTOMER ORDER FORM

DNA BARCODING SERVICE
No. B/7.5.0/FM/034 / Rev. 00

REPORT TO (information to be listed on the final report of the study) INVOICE TO (please tick ✘ if it’s the same as report to)
Name Yuliana Prasetyaningsih Name
Institution Fakultas Biologi UGM Institution
Address Address
City Sleman State/Province Daerah Istimewa Yogyakarta City State/Province
Post Code 55281 Country Indonesia Post Code Country
Phone +62 819-1130-4728 Phone
Email [email protected] Email

Sample Requirements
PLEASE SPECIFY THE SAMPLE SOURCE AND PARTS
SAMPLE TYPE RAW SAMPLE TYPE Target Gene or Primer Name
(e.g., paddy root, chicken gut, nasopharyngeal swab, cow feces, etc.)
DNA Bacterial Isolates
✘
Feses Ayam ✘ 16s rRNA (~1400bp)
✘ RAW Sample*
* Requires Extraction and
extra charges apply. Fungal Isolates ITS (~700bp) NL (~600bp)

Plant Tissue rbcl (~600bp) matK (~850bp)

Animal Tissue 18S (~1500bp)

Fish Tissue COI (~700bp) LCO-HCO (~700bp)

Insect Tissue LepF1/ LepR1 (~700bp)

Other

Sample Information
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PT. GENETIKA SCIENCE INDONESIA
Rukan Great Wall Blok C 19-21, Green Lake City, Kel. Petir, Kec. Cipondoh, Kota Tangerang, Banten, 15147, Indonesia.
Telp. 021 5433 2034, 021 5433 2425, Fax. 021 5433 2701
 For internal use only:
CUSTOMER ORDER FORM
DNA BARCODING SERVICE
No. B/7.5.0/FM/034 / Rev. 00

gDNA/RNA Sample
No. Sample Name/Code Expected Species Additional Information Conc. Vol
A260/280 A260/230
(ng/uL) (uL)
1 T2.11 Salmonella shigella
2
3
4
5
6
7
8
9
10
if you have more samples than given table, please attach a separate sheet with the details as requested in this table

ADDITIONAL SERVICES (Charged)

QUANTITY
(Please “[x]”)
PCR Product Cloning

Phylogenetic tree by software MEGA

Protocol Species Barcoding

Gel Photo in JPEG file

✘ By completing this form, or submitting samples for analysis, or by authorizing PT. Genetika Science Indonesia to perform the services, including but not limited to the issuance of a purchase order, I

hereby accept the Term and Conditions issued by PT. Genetika Science Indonesia.
Note: All samples and sequencing data will be kept confidential. If not specified by the customer, all samples will be discarded 3 months after results are released.

Page 2|2
PT. GENETIKA SCIENCE INDONESIA
Rukan Great Wall Blok C 19-21, Green Lake City, Kel. Petir, Kec. Cipondoh, Kota Tangerang, Banten, 15147, Indonesia.
Telp. 021 5433 2034, 021 5433 2425, Fax. 021 5433 2701