SAMPLE SUBMISSION FORM

Include this form with all sample shipments

Please fill out ALL requested information in the form below. Send an electronic copy to episervices@activemotif.com (North America), euro-orders@activemotif.com (Europe), or japantech@activemotif.com (Japan) and include a completed hard copy with your sample shipment.

If you would like to include multiple order numbers, quote numbers, investigators, emails, and phone numbers, please separate them with commas.

If you completed your Profile in the portal, you could.

Client Information

Company/Institution:

Investigator Name:

Purchase Order #:

Quote #:

Mailing Address:

City, State:

Postal Code:

Country:

Email:

Telephone:

Person to receive results

same as Investigator above

Recipient Name:

Mailing Address:

City, State:

Postal Code:

Country:

Email:

Telephone:

To ensure accurate processing, please submit a separate form for each assay if you are submitting samples for multiple assays.

Please ensure that ALL required information is provided for each sample. If a field is not applicable, the information is unavailable, or cannot be disclosed due to confidentiality, enter “N/A”.

For frozen tissue, please indicate if you would like us to use the entire sample for a single reaction or if we may excise a portion.

Sample Information

Assay:

Sample Adding Options

Download and complete our Sample Information Template and upload it here:

Manually add samples with the "Add New Sample" button below.

Sample #¹	Sample Name	Pooled With² (Enter sample # from 1st column)	Cell Line, Primary Cells or Tissue³	Cell Type⁴	Species	Number of Cells or Weight	Viability	Other Comments (DNase treatment? (Y/N); Proceed with 50-70% viable cells? (Y/N))	Replacement For⁵
No Sample

New Sample

Sample #¹:

Sample Name:

Pooled With² (Enter sample # from 1st column):

Cell Line, Primary Cells or Tissue³:

Cell Type⁴:

Species:

Number of Cells or Weight:

Viability:

Other Comments: (DNase treatment? (Y/N); Proceed with 50-70% viable cells? (Y/N))

Replacement For⁵:

¹Sample numbers are sequential integers starting from 1.

²For samples that will be pooled into a single reaction, use the same name in the “Sample Name” column for all pooled tubes. Additionally, list the sample numbers (from the 1st column) of the tubes to be pooled under “Pooled With” to specify the grouping.

³If using a cell line, write the name of the cell line in the provided space. If using primary cells or tissue, indicate “primary cells” or “tissue”. Other suitable answers may be biopsy, xenograft, sorted primary, etc.

⁴Cell type refers to cellular origin or tissue type. For example, if using HL60 cells, cell type would be promyelocytic leukemia. Other answers might include T-cells, CD4+ T-cells, hepatocytes, neurons, etc.

⁵If adding a replacement sample, please provide the original sample numbers (from the 1st column) under “Replacement For”.

BIOINFORMATICS ANALYSIS REQUEST FORM

To provide the greatest value to our customers, Active Motif requires the following information be provided in conjunction with the sample submission form. This form is intended as a guide for our bioinformatics scientists to process samples using our standard pipelines in a way that is most compatible with the design and goals of each project. Any re-analysis that is required due to incomplete or inaccurate information may be charged at our standard bioinformatics rate. Active Motif may not be able to provide all requests on this form. For an overview of our standard offerings or deliverables, please see Active Motif Boinformatics Analysis . Contact your Account Manager for more information.

Data files will be available for 3 months after delivery, after which they will be deleted. Active Motif is not liable for data retention or retrieval after the deletion.

Provide a description of your experimental design.
Describe your goals for the bioinformatics analysis. (i.e., Identify Differential Regions)
To which species genome build do you want your data aligned? (Required*)
If you do not provide a specific request, Active Motif will use our default genome. (i.e., human: hg38, mouse: mm10, rat: rn6)
Bioinformatic service add-on: For an hourly rate we can perform data analysis and/or data integration with previous Active Motif Epigenetic Service data sets. If you would like this service add-on, please provide the quote number, sample names, and other relevant information.
Note: We may not be able to accommodate every request, and will reach out if necessary.
How should the samples be grouped for analysis? (i.e., S1: WT, S2: KO)
For ChIP-Seq, ATAC-Seq, RNA-Seq, RRBS, or CUT&Tag, how should the groups be compared for differential analysis? (i.e., WT vs KO)

(ChIP-Seq only) If we are generating input data from more than one sample, please specify which samples are to be analyzed with each input.
(Discover-Seq only) Please provide guide RNA (sgRNA) sequences for the samples to proceed with Discover-Seq analysis and identify double-stranded DNA cuts with respect to the CRISPR system.
If we are analyzing your data using an input from a previous Active Motif Epigenetics Service, please provide the project number and other specifics related to that input sample.

Additional Information

Please use this page to provide any additional information, recommendations, or data about your samples that may assist us to provide the best possible service.

Attachments

Attachment(s):

The total size of all attachments should NOT exceed 20MB.

Total size of the attachments exceeds 20MB!

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SAMPLE SUBMISSION FORM

Form ID:
KAM:

Client Information

Company/Institution:
Investigator Name:
Purchase Order #:
Quote #:
Mailing Address:
City, State:
Postal Code:
Country:
Email:
Telephone:

Person to receive results

Recipient Name:
Mailing Address:
City, State:
Postal Code:
Country:
Email:
Telephone:

Sample Information

Service Type:
Pooled Library Concentration (nM):
Pooled Library Volume (µl):
Index Type (Optional):
Qubit Quantification (ng/µL):
Sequencer and Flow Cell:
Average Fragment Size (bp):
Species (Optional):
Read 1 Sequencing length (bp):
Index 1 length (bp):
Read 2 Sequencing length (bp):
Index 2 length (bp):
Do you have a custom primer?
Custom Primer Index:
Library Prep Kit Used:
Assay:

Attachment(s):

SAMPLE SUBMISSION FORM

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Sample Information

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BIOINFORMATICS ANALYSIS REQUEST FORM

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