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* Subject

* Name

* Company or Affiliation

* Email

* Address 1

Address 2

* City

State

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Please indicate all applications in which you are interested: Chiral Separation
Recombinant Protein Purification
Antibody Purification
Other Purification

Please Indicate All Chromatographic Methods You Currently Use: Ion Exchange
Size Exclusion/Gel Filtration
Antibody Affinity
Histidine Tag/IMAC
Reversed Phase Chromatography
Lectin Affinity Chromatography
Chiral Chromatography
Other Affinity Chromatography

What is Your Target Yield per Day for Protein Purification: 100 to 500 milligrams/day
500 to 1000 milligrams/day
More than 1000 milligrams/day

What is Your Target Yield per Day for Chiral Separation: 1 to 10 milligrams/day
10 to 100 milligrams/day
More than 100 milligrams/day

* Timeframe for Purchase of an Octave SMBC System Immediately
Zero to Six Months
Six to Twelve Months
More than 12 Months

* Do you currently have a budget? Yes
Applied for
No

If yes, what amount (US$) is allocated for SMB equipment & supplies? < $10000
$10000 - $50000
$50000 - $100000
> $100000

Special System Requirements

If not proprietary in nature, please tell us about your intended SMBC application