MagQu LLC
                                                                                                               12425 W Bell Rd, C107, Surprise, AZ 85378
                                                                                                                                   Tel: 1-623-792-8888  
                                                                                                         SERVICES APPLICATION FORM
         Company/Institute                                                                                                                                               　Date (dd/mm/yy)
         Customer Name                                                                                                                                                   　Quotation No.
         Phone                                                                                                                                                           　Remark
         E-mail
                                                                                                                                                                                                                     Blank marked in red is for internal use of MagQu.
                                                                                                                                                                                                                            ！！　Attention　！！
                          Detection Category                                                                               Test Items　( n )                                                                                        sample demand
                                                                                                                                                                                                               Please note eppendorf capacity limits to avoid  
                                                                                                                                                                                                                             contamination of the sample
                 Serum                                                                      α-synuclein                                              p-α-synuclein                                  　 n = 1，sample demand  0.5 ml up
                 Plasma                                                                     Tau                                                      p-Tau                                          　 n = 2，sample demand  1 ml up
                  AAnanallyzyzee da dattaa                                                  A β 40                                                   Other                                          　 n = 3，sample demand  1 ml up
                                                                                                                                   ____________                                                     　 n = 4，sample demand  1.5 ml up
                  Other                                                                     A β 42                                                                                                  　 n = 5，sample demand  2 ml up
         　 ____________________
                                                                                                                                         Sample List
                                                                                                                 （please fill in,or another sample list）
             No.                         Sample Name                                    No.                      Sample Name                                 No.                      Sample Name
               1                                                                         26                                                                   51
               2                                                                         27                                                                   52
               3                                                                         28                                                                   53
               4                                                                         29                                                                   54
               5                                                                         30                                                                   55
               6                                                                         31                                                                   56
               7                                                                         32                                                                   57
               8                                                                         33                                                                   58
               9                                                                         34                                                                   59
              10                                                                         35                                                                   60
              11                                                                         36                                                                   61
              12                                                                         37                                                                   62
              13                                                                         38                                                                   63
              14                                                                         39                                                                   64
              15                                                                         40                                                                   65
              16                                                                         41                                                                   66
              17                                                                         42                                                                   67
              18                                                                         43                                                                   68
              19                                                                         44                                                                   69
              20                                                                         45                                                                   70
              21                                                                         46                                                                   71
              22                                                                         47                                                                   72
              23                                                                         48                                                                   73
              24                                                                         49                                                                   74
              25                                                                         50                                                                   75
                                            Application signed / Date
                                         MagQu LLC
                                    12425 W Bell Rd, C107, Surprise, AZ 85378
                                          Tel: 1-623-792-8888  
                                  SERVICES APPLICATION FORM
   Company/Institute                                   　Date (dd/mm/yy)
   Customer Name                                       　Quotation No.
   Phone                                               　Remark
   E-mail
                                                                     Blank marked in red is for internal use of MagQu.
                                              List
    NO.        Report file number     Quantity         Provide the date
     1
     2
     3
     4
     5
     6
     7
     8
     9
     10
                                            Application signed / Date
Blank marked in red is for internal use of MagQu.
！！　Attention　！！
  sample demand
Please note eppendorf capacity limits to avoid  
contamination of the sample
sample demand  0.5 ml up
sample demand  1 ml up
sample demand  1 ml up
sample demand  1.5 ml up
sample demand  2 ml up
  No.     Sample Name
  76
  77
  78
  79
  80
  81
  82
  83
  84
  85
  86
  87
  88
  89
  90
  91
  92
  93
  94
  95
  96
  97
  98
  99
  100
Blank marked in red is for internal use of MagQu.
List
         Remarks