DURECT CORPORATION ORDER FORM Please e-mail: [email protected], or fax: (408) 865-1406 Shipping Information (if different from Billing) Billing Information Name: Organization: Address: Name: Organization: Address: City: State: County (CA & AL only): Country: Telephone: Fax: Zip: City: State: County (CA & AL only): Country: Telephone: Need by Date: Order placed by (Required): Telephone (Required): E-mail (Required): Purchase Order # Credit Card # Exp. Date: FedEx Account number and/or Broker Information (for int'l D&T and/or 3rd party shipments): Special Instructions? Chemical Name Abbreviation Zip: Security Code: Inherent Viscosity (IV) 50:50 Poly[DL-lactide-co -glycolide] 50:50 DL-PLG 0.15 - 0.25 0.26 - 0.54 50:50 Poly[DL-lactide-co y[ -glycolide] gy ] 50:50 DL-PLG 50:50 Poly[DL-lactide-co -glycolide] 50:50 DL-PLG 0.55 - 0.75 0.65 - 0.85 50:50 Poly[DL-lactide-co -glycolide] 50:50 DL-PLG 0.76 - 0.94 50:50 Poly[DL-lactide-co -glycolide] 50:50 DL-PLG 0.95 - 1.20 50:50 Poly[DL-lactide-co -glycolide] 50:50 DL-PLG 0.55 - 0.75 65:35 Poly[DL-lactide-co -glycolide] 65:35 DL-PLG 0.55 - 0.75 75:25 Poly[DL-lactide-co -glycolide] 75:25 DL-PLG 0.55 - 0.75 85:15 DL-PLG 85:15 Poly[DL-lactide-co -glycolide] 0.15 - 0.25 DL-PL-COOH Poly[DL-lactide-COOH] 0.15 - 0.25 50:50 Poly[DL-lactide-co -glycolide]-COOH 50:50 DL-PLG-COOH 0.55 - 0.75 50:50 Poly[DL-lactide-co -glycolide]-COOH 50:50 DL-PLG-COOH 0.26 - 0.54 DL-PL Poly[DL-lactide] 0.55 - 0.75 Poly[DL-lactide] DL-PL 0.90 - 1.20 L-PL Poly[L-lactide] 0.65 - 0.85 Poly[ε-caprolactone] PCL 1.00 - 1.30 Poly[ε-caprolactone] PCL 0.70 - 0.90 25:75 Poly[DL-lactide-co-ε-caprolactone]* 25:75 DL-PLCL 0.70 - 0.90 80:20 Poly[DL-lactide-co-ε-caprolactone]* 80:20 DL-PLCL Note: Individual items are GMP grade GMP Order # Quantity (20g minimum) B6017-1 B6010-1 B6010-2 B6029-1 B6010-3 B6010-4 B6001-1 B6007-1 B6006-1 B6014-1 B6013-1 B6013-2 B6005-1 B6005-2 B6002-2 B6003-1 B6003-2 B6015-1* B6016-1* *Not routinely stocked. Please call for quote and availability. Sample Kits - (10 grams per sample) Order # Sample Kit A: 5 samples of 50:50 DL-PLG ranging in IV from 0.15-1.2 dL/g. All polymers have ester end group unless acid end group is requested. Sample Kit B: 3 samples of DL-PLG ranging from 50-100 mole % DL-lactide, IV range 0.55-0.75 dL/g SK-A SK-B Sample Kit C - 2 samples of crystalline homopolymers (L-PL & PCL) SK-C Custom Kit 1 - 4 samples of any polymers listed above. Please list items in special instructions. CK-1 Quantity We will confirm within 72 hours to verify shipping and pricing information. Orders subject to DURECT's terms and conditions. Phone: 877-705-8072 - Fax: 408-865-1406 - E-mail: [email protected] Thank You For Your Order
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