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Transfection Reagent Sample Request Form

Complete this qualification form to request a sample of FuGENE® 4K, FuGENE® HD or ViaFect™ Transfection Reagent (200µl). A Promega representative may contact you with further questions to ensure qualification.^†

MS-2024-FuGENE Transfection Reagent Sample Request

First Name*

Last Name*

Email*

Company/Institute*

Lab Name*

Department*

What transfection reagent are you looking to sample?

FuGENE® 4K Transfection Reagent

FuGENE® HD Transfection Reagent

Viafect™ Transfection Reagent

Do you currently perform transfection?*

Yes

What method(s) do you currently use to transfect your cells?

Lipid or chemical reagent

Viral transduction

Electroporation

If you use a lipid or chemical reagent for transfection, what system(s) are you currently using?

Invitrogen (Lipofectamine™ 3000, etc.)

Mirus (TransIT® Transfection Kit)

Roche (X-tremeGENE™)

Qiagen (Effectene®, etc.)

FuGENE® (HD, etc.)

Other

If Other, please specify

Why are you looking for a new transfection reagent?

I need better transfection efficiencies

I would like less toxicity for my cells

I am working with new cell lines

I would like a single reagent I can use with many cell lines

Other

If Other, please specify

On what cell line(s) will you test this sample?

How did you FIRST hear about FuGENE® 4K?

If Other, please specify

Shipping Address

Street Address*

City*

Country*

State/Province*

Zip Code*

Phone*

How would you like to be contacted*

Phone

I have read and agree to the Promega Guidelines for Processing Personal Information (see link below)*

Promega Guidelines for Processing Personal Information ›

I agree to receive e-mails about events, promotions, surveys, products and technologies.*

yes

†The FuGENE® 4K Transfection Reagent sample (200µl), FuGENE® HD Transfection Reagent (200µl), and ViaFect™ Transfection Reagent (200µl) are only available to qualified customers. This request may have additional local or country specific qualification requirements and may not be available in all geographical areas. Limit one request per customer. Cannot be combined with other discounts or promotions. Offer void where prohibited, licensed or restricted by federal, state, provincial, or local laws, regulations, or agency and institutional policies. Other restrictions may apply.

Please allow 2-4 weeks for your request to be approved and processed. Please allow up to 6 weeks for delivery. For Research Use Only. Not for use in diagnostic procedures.

Americas

Brazil

Canada

United States

Pacific Asia

Australia

China

India

Japan

Korea, Republic of

Singapore

Europe

Austria

Belgium

Denmark

(Incl. Faroe Isl. & Greenland)

Estonia

Finland

(Incl. Åland)

France

Germany

Ireland

Iceland

Italy

Luxembourg

Netherlands

Norway

(Incl. Svalbard)

Poland

Spain

Sweden

Switzerland

United Kingdom