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PerkinElmer ATP Lite Sample Kit Redemption Form

PerkinElmer Phenovue Reagents Q1 Survey Form

Fill up the forms and our PerkinElmer Representative will contact you.

By providing your contact information above, you are consenting that PerkinElmer may contact you at the phone and e-mail address provided, and that you expressly consent to receiving future marketing communication. If you wish to withdraw consent or be removed from future marketing communications, contact PerkinElmer in writing or unsubscribe.

1. Which country are you based? *This question is required.

2. Email *This question is required. This question requires a valid email address.

3. First name *This question is required.

4. Last name *This question is required.

5. What is your role? *This question is required.

Please enter an 'other' value for this selection.

6. Institute/Lab/Clinic/Company *This question is required.

7. Department

8. Phone number *This question is required. This question requires a valid number format.

9. Address *This question is required.

10. Postal Code / Zip Code *This question is required.

11. What assays are you using for measuring cell viability currently? *This question is required.

12. What type of cells are you working with? *This question is required.

13. Do you have a microplate reader which can detect Luminescence? *This question is required.

14. Which product would you like a sample of *This question is required.

ATPlite
ATPlite 1step
ATPlite 3D
ATPlite 1step 3D

15. If you are satisfied with the performance of our trial kit, how many kits will you purchase in a year *This question is required.

16. Comments (if any)