Make an order (sequencing only) – Breda Genetics srl

Order type

Order type *

Menu (standard price) [check price on bottom of page]

I have my own quotation

Quotation number *

Please enter quotation number

Internal order switcher

Staff member

Staff member email

Sender's details

Title *

Name *

Surname *

Email address *

Company / Institution *

Department [optional]

Street *

Number *

City *

Postal code *

Country *

Phone Number *

Fax (optional)

Results in cc to (Title and name)

Results in cc (email address)

Sender's details (internal)

Customer

Title

Name *

Surname *

Email address *

Company / Institution *

Department [optional]

Street *

Number *

City *

Postal code *

Country *

Phone Number *

Fax (optional)

Email for results in cc

Billing details

Billing *

Sender

Company / Institution

Patient / Other (e.g. Charity)

Please add invoicing details, which may be retained for future orders.

Tax code / VAT number (Sender / Patient / Other) *

If any, please enter local tax code.

VAT number (company/institution)

If any, please enter company / institution VAT number or tax code

Email address (billing) *

Name (Payer / Charity association) *

Surname (Payer)

Full address (Payer) *

(Street, number, postal code, city.

Country (Payer)

[Calculations]

[Calc - for results in cc]

Sample details

Data delivery

Summary of sample codes

Special requests

Payment method

Invoice

Now by PayPal (-5%)

Total price

RSEQ number

Registration opt-in

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