BRIGHTFIELD SLIDE SCANNING REQUEST
Principal Investigator :
P.I. Email :
P.I. Phone :
P.I. Affiliation :
Contact Person (if not P.I.) :
Contact Email :
Contact Phone :
Billing Number : Date:
Number of Slides Submitted :
Magnification : 20X ¦ 40X
Slide Type : Standard (25x75mm) ¦ Double (52x76mm)
Folder Name : - (optional folder name)


Input the names of your slides in the SAME order in which they will be submitted
Limit to ≤ 16 characters - Alphanumeric only
DO NOT USE THE FOLLOWING CHARACTERS:
# / \ ; : [ ] { } . , & ! @ $ ^ * )(

Estimated Cost : $0.00


Optional - For your records only