This form will establish that you are a member of the life sciences community and that you have a legitimate reason to order synthetic nucleic acids. Providers of these materials, such as companies, core facilities, and biofoundries, may ask you for this information.
Note: For orders containing sequences of concern (SOCs) that may pose a biosafety or biosecurity risk, an additional SOC Order Form is recommended.

PART 1. CUSTOMER INFORMATION
You may be asked to verify this information, for example by confirming access to your email or phone number, providing identity documents, or responding to inquiries from customer service agents.

1.1 Your Information
Name	
Institution	
Website link	
Email	
Phone number	
Shipping address	
If you are not affiliated with a life sciences institution, or if your email or shipping address does not match the institution listed, please explain:

1.2 Will you or your close collaborators be the end users of the synthetic nucleic acids you order?
	Yes, I will use the sequences I order myself or will work closely with others using them. I understand the intended use of the materials I order.  You have completed the form.
	No, I am ordering on behalf of others and/or am unfamiliar with the intended use of the materials I order.  Please complete Part 2 of this form.

PART 2. CUSTOMERS ORDERING FOR OTHER END USERS
You should fill in Part 2 if you are ordering synthetic nucleic acids for another end user, for example if you conduct procurement for an academic department, purchasing for a life sciences company, or act as a supplier or reseller of life sciences products.

2.1 What type of life sciences institution are you affiliated with?
	Research institution (e.g. academic, non-profit, governmental)
	Company
	Supplier of life sciences products or services
	Other:

2.2 Will the synthetic nucleic acids you order be used only within your institution?
	Yes.  Complete 2.3 Additional Institutional Contact only.
	No.  Complete 2.4 Additional Information for Suppliers and Resellers only.

2.3 Additional Institutional Contact
This person may be contacted to assist in verifying that you are a member of the life sciences community with a legitimate reason to order synthetic nucleic acids.
Name	
Title	
Email	
Phone number	
Link with additional information

2.4 Additional Information for Suppliers and Resellers
You should answer questions 2.4.1 and 2.4.2 (on the next page) if the synthetic nucleic acids you order will be sent to customers or end users outside of your institution.

2.4.1 Attach or provide a link to one or more kinds of documentation to establish that your institution is legitimate. You may include documentation that shows one or more of the following (check all that apply):
	Institution is an established legal entity (e.g. official incorporation documents, business license, tax documents)
	Institution has a mission or purpose that includes life sciences (e.g. annual report, grant documents, contracts)
	Institution provides biosafety oversight or training (e.g. documentation of biosafety oversight, codes of conduct)
	Institution is part of the scientific community (e.g. scientific publications, participation in relevant conferences, Material Transfer Agreements with established life sciences institutions)
	Institution has obtained regulatory approval or official certification for work with life sciences materials (e.g. local approvals such as fire safety inspections, national approvals to work with GMOs such as U.K. HSE form CU-1 or Australia OGTR license)
Describe the documentation you have provided and what it shows:

2.4.2 Will you be sending or transferring synthetic nucleic acids to locations outside the country of your shipping address?
       Yes. If yes, list countries:
       No.