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: 855-873-4558
E-mail: peptide@celtek-services.com
Fax: Print out this form and fax it to 615-567-8038*
* Viewing form requires Adobe Acrobat Reader.

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.

chart
 

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.