Rockland Marketing -

Questionnaire for Custom CRISPR Services

Please provide your contact information along with your modification, gene, and/or cell line information below.

1. Contact Information

Full Name*

Job Function

If other, please specify:

Company Name*

Email*

Phone*

2. Modification Information

Type of Modification*

3. Gene Information

NCBI Gene ID or Ensembl ENSG# or ENST#*

Parental Sequence (include 50bp upstream and downstream)

Mutation Sequence (include 50 bp upstream and downstream)

4. Cell Line information

Cell Line Name*

Cell Line Source

Required Culture Conditions

Doubling Time (if known)

Clonality (if known)

Ploidy (if known)

When are you looking to start?

Additional Comments or Questions: