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Hepatocytes

Microsomes & S9

Human Renal Proximal
Tubule Cells

Characterization tables

Fresh Flash™
Hepatocyte Notification email

Custom Product Form

First Name*:

Last Name*:

Organization*:

Address 1*:

Address 2:

City*:

State / Province*:

Zip Code / Postal Code*:

Country:

Country, if not listed
in the dropdown box above:

Your E-mail*:

Your Phone*:

Your Fax:

Organization Category:

Please fill out custom product request form for ONE custom product only. Form will prompt you to submit additional custom product requests once the first custom product form is submitted. Your contact information will be maintained throughout each additional submission.

Date Product is Needed

What product are you requesting?

Fresh or Frozen?

Fresh Frozen

Format

# of Vials

# Cells/ Vial

6-well plate collagen coated

12-well plate collagen coated

24-well plate collagen coated

48-well plate collagen coated

96-well plate collagen coated

12.5-cm² T-Flask collagen coated

75-cm² T-Flask collagen coated

175-cm² T-Flask collagen coated

Suspension (minimum qty 10 million cells)

Other

	Specialized Medium
	Other
	select amount required
	Medium Size	Quantity
	250 mL bottle
	500 mL bottle
	1 L bottle
	Other
Please provide additional information on medium product specifications below (i.e. sterility, endotoxin, testing, pH, etc.).
Additional Information:

Tissue will need to be acquired?

IVT to acquire tissue Customer will provide tissue Other

What Species?

Single male

	Age Requirements	Yes No
	Medical Requirements	Yes No
Other requirements

Single female

	Age Requirements	Yes No
	Medical Requirements	Yes No
Other requirements

Male pool

	Quantity
	Age Requirements	Yes No
	Medical Requirements	Yes No
Other requirements

Female pool

	Quantity
	Age Requirements	Yes No
	Medical Requirements	Yes No
Other requirements

Mixed gender pool

	Quantity	males: females:
	Age Requirements	Yes No
	Medical Requirements	Yes No
Other requirements

Single male
Single female
Male pool	quantity:
Female pool	quantity:
Mixed gender pool

Below is a list of custom product specifications. In producing your product, what items must be considered for your custom request?

Provide specific product testing or product qualification

What research/application areas are used in your lab?

Toxicity
Absorption
Metabolism
Induction/Inhibition
Other

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