Sample Evaluation Form

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Sample Evaluation Form

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Sample Evaluation Form

MACHEREY-NAGEL appreciates your feedback on the sample kit you have tested.
We are continuously working to improve our product quality and customer service.

Your contact information:

First Name*	Surname*
Company/University*
Department/Institute*	Working Group
Street	Address extension
Postal code	City
Country	Phone
Fax	E-Mail Address*
Name of sample kit:	Received on
All fields marked with an asterisk (*) are required.
Your application:
Isolation of DNA clean-up:PCR clean upGel extraction
Plasmid DNA: High CopyLow Copy	plasmid size
Genomic DNA:	Which kind?
RNA:	Which kind?
Viral nucleic acids:	Which kind?
Starting material	Amount/Volume
Protocol modified YesNo	Homogenization method
Downstream application
Currently used method/kit

Your results:
Yield determined by	Value	Better than current method YesNoSame
Purity determined by
A₂₆₀/A₂₈₀	Value	Better than current method YesNoSame
A₂₆₀/A₂₃₀	Value	Better than current method YesNoSame
Preparation time/handling

Results of downstream application

Your opinion:
Satisfied with results YesNo	If not satisfied, please specify why
Handling: Overall impression Very goodGoodOKBadVery bad	If negative, please specify why
Further notes (about handling, protocol, convenience)
How did you become aware of the possibility of testing a free sample of MN?	If other, please specify
ColleagueInternetFlyerSales rep.Other

How would you like to proceed Please send a quote, specify REF and amount: Your sales representative should contact you. No further process	REF and amount:

Please send further info material about:
Thank you for filling out this form. Your feedback is highly appreciated!





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