Q-TOF PTM Analysis Submission Form Purpose: To characterize the post-translational modification state of proteolytically or chemically cleaved protein fragments Customer Details Contact Name: Phone: E-Mail: Billing Address: Principal Investigator: Fax: Organisation/Lab: Customer #: Sample Details Sample name: Type of PTM suspected: Sample format: solid/liquid//gel c phosphorylation Approximate MW: c glycosylation Approximate pI: c other Additional Notes: (Please provide any additional details relevant to the sample) Species: Quantity of protein pmole. Concentration µM. Estimated purity(%) Method of purification: If purified by electrophoresis please state stain used: If the sample is a liquid, what solution is the sample in? Please state buffer and salt concentrations: # Of suspected PTM sites: Cleavage agent: eg. Trypsin, CNBr, etc. Special handling of sample: For database searching please include the chemicals used for reduction and alkylation, if any: Send Sample To: Dr. David Hyndman Protein Function Discovery Facility Queen's University 614 Botterell Hall, Stuart St., Kingston, ON Canada E-mail: [email protected] Phone: 1-613-533-2944 Fax: 1-613-533-2497 I have read and understood the PFD Mass Spectrometry Price List and agree to the charges. I have also prepared the sample(s) according to PFD’s guidelines (available upon request) Print Name Sign Name Date Samples are placed in a queue upon receipt with the completed form. For urgent and other services, please contact us via e-mail [email protected]. Payment by credit card preferred.