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Whole Genome Genotyping quote form

* are required fields.

Species or scientific name*
Expecting turnaround time*
(Example: by the end of Dec. 2013)
Species*






Chip type
Number of samples*
Name* Family Name  First Name
Institution*
Laboratory/Unit*
Postal Code
(Example:123-4567)
Prefecture/Country* If you live outside Japan, please choose "Overseas" from the "Prefecture or State" menu, then choose the name of your country.
Prefecture or State   Country
Address1*
Address2
e-mail Address* (alphanumeric characters )
(Example:foo@example.com)
※Please enter again just in case
Phone Number*
(Example:+81-3-1234-5678)
FAX Number
(Example:+81-3-1234-5678)

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