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| Name: |
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| Department: |
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| Institution: |
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| Mailing
Address 1: |
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| Address
2: |
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| City: |
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| State/Province: |
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| Zip
Code/Postal Code: |
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| e-mail
address: |
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| Telephone: |
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| Model
(choose one): |
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| Adjustable
Volume: |
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| Fixed
Volume: (enter volume) |
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| Multichannel: |
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| Electronic Single Channel: |
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| Electronic Macro: |
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| Serial
Number: |
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| Date
Purchased: |
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| Distributor: |
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| The
Ovation Pipette will be used for the following applications: |
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| If
you selected "other, please indicate your industry: |
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| The
Ovation pipette will be: |
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| How
many hours/day do you typically pipette? |
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| How
many others in your institution use manual pipettes? |
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How did you first learn about
Ovation pipettes?
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