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Fluorescence Filter Request Information Form

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3rd Millennium

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Cleaning Filters

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Note: if you are requesting quotations for more than one filter you only need give your contact information once. All forms however must contain your Name, Organisation and Country.

* Surname:

Initials:

Title:

* Organisation:

Dept:

Address:

 

Town:

Postcode:

* Country:

 

 

 

 

 

Telephone:

Fax:

E-mail:

Please keep me up-to-date with product information

 

My Interest is:

Information only
Possible purchase

I have funding
I am applying for funds

I intend to purchase:

Now!
Within 3 months
Within 6 months
Within 12 months
Next year

Please give as much information as you can:

Just send general information

Application

Type of Filter

Excitation
Emission
Dichroic
All (set)
Filter Block

Light Source

Detector

Fluorescence Dye Used

Holder type

Dye Excitation or Absorption max.
(if known, nm)

Microscope or Instrument Type

Dye Emission max.
(if known, nm)

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