ANYGEN CO. LTD. Rm.305, Pilot plant, Gwangju Technopark, 333

Cheomdan gwagi-ro, Buk-gu, Gwang-ju, Korea

TEL.+82-62-714-1166 / FAX.+82-062-714-1188

E-mail : order@anygen.com

No.

Test Analysis Request Form

Name	Type	Molecular weight	Condition and Amount	etc.
	□ Peptide □ Protein □ etc..	Da
	□ Peptide □ Protein □ etc..	Da
	□ Peptide □ Protein □ etc..	Da
note:

Company				Name
Address
Contact Information	TEL) FAX)
e-mail
In Charge (Payment)		Contact Number (Payment)	TEL)
E-mail (Payment)

We request a test analysis as above.

20  .   .

Applicant               (Signature)