Order/Quote Request

You can order your peptides or ask for a peptide synthesis quote by phone, email, fax or by filling out the online form below:

Toll-free Phone: 800-399-6558
E-mail: peptide@celtek-bioscience.com
Fax: Print out this form and fax it to 615-399-7090.*
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We accept PO or credit card payments

Ordering/Quotation Form

Please fill out all fields of the form to make a custom peptide synthesis order or receive a prompt quotation for your peptide(s).

This order is for: (please select one)

Ordering

Quotation

First Name

Last Name

Company

Street Address

City

State

Zip

Country

Phone

Fax

E-Mail

Please enter the complete amino acid sequence of your custom peptide into the field below, starting from the N-terminus. Use standard three-letter abbreviations or one-letter abbreviations. If you have several peptides, please indicate their numbers and separate them by some spaces.


N-terminus:
free amine	acetyl-blocked
other N-term modification:
C-terminus:
free acid	amide-blocked
other C-term modification:
Purity Required:
desalted 70% 80% 90% 95% 98%
other purity requirement:
Quantity Required:
5mg 10mg 20mg 30mg 50mg 100mg
other quantity requirement:
		Please provide any special instructions or comments into the field at the left in relation to your desired peptides (such as the use of unusual amino acids):
Billing Information (for ordering only):
Contact Person
P.O. Number
Company
Billing Address
City
State
Zip
Country
Telephone
Fax

Celtek Peptides will review all peptide synthesis orders prior to synthesis. If we determine that certain peptides contain difficult sequences and/or require unusual procedures, the customer will be informed in advance.