PCR BUFFET Program Application Form

Section 2: Principle Investigator Information
Principal Investigator Name

First NameLast Name
Institution
Department
Section 3: Laboratory Information
Number of Laboratory Staff
Key Applications (Select all that apply):*

PCRqPCR (Dye-Based)RT-qPCRReverse Transcription (RT)Other
Level of Support Desired (Select one):*

Spend $1,000 USD to receive $3,000 USD worth of PCR reagents for one yearSpend $3,000 USD to receive $15,000 USD worth of PCR reagents for one yearSpend $5,000 USD to receive $100,000 USD worth of PCR reagents for one year
Please provide any additional details or comments that may support your application:

Section 4: Submission & Agreement
By submitting this form, you affirm that all information provided is accurate to the best of your knowledge. You also acknowledge and agree to abide by the program’s limitations, including:
- Reagents received under this program must be used exclusively by the designated laboratory during the program period.
- Any violation of the program’s terms may result in termination of benefits and/or compensation for our market loss at the sole discretion of Applied Biological Materials Inc. (abm).
Signature*

Clear
Date*

MonthDayYear
Disclaimers
- Eligibility: Offer valid for new customers from academic institutions in the USA and Canada only.
- Restrictions: Cannot be combined with other promotions or discounts. Void where prohibited by law. Some restrictions may apply.
- Approval Rights: Applied Biological Materials Inc. reserves the right to approve or decline applications and modify the program at its sole discretion.
Should be Empty:

PCR Buffet Program Application Form