Filter Order Form

9_36035
Filter Order Form
Customer Information
Institute/Customer Name:
Customer Number:
Contact Name:
Address 1:
Address 2:
City:
State:
Zip Code:
Country:
Purchase Order Number:
Phone:
Fax:
Email:
Shipping Address
Use The Same Address
For Shipping: Yes
No
Address 1:
Address 2:
City:
State:
Zip Code:
Country:
Phone:
Fax:
Microscope
Microscope Manufacturer:
Type Or Model Of Microscope:
Approximate age of
the microscope:
Check all that apply
All filter sets are mounted in individual cubes that can be moved in and out of the head of the microscope.
All filter sets are mounted in sliders.
Max number of filter sets that the slider holds:
Number of filters currently in the slider:
Filter sets are mounted in a revolving turret in the head of the microscope.
The microscope is attached to a computerized imaging system.
The imaging system was purchased from:
Answer if a filter wheel is used to house the exciter filters
Number of filters currently in the slider:
Number of empty slots in the filter wheel(s):
Filter wheel manufacturer:
Action
Bandpass Fluorophores Mounting Filter Holder Quan.
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Comments
Please click the submit button below to send your information to us.

Thank you, your request has been received.
An email confirmation has been sent to your email address.