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ELISA Kit Problem Report Form (PROB-2)
Use the form below to report a problem with an ELISA kit. Red fields are required.
Investigator Name:  *
Institution:  *
Email Address:  *
Phone Number:  *
FAX Number:  *
Shipping Address:  *
Address 2:
City:  *
State:  *
Province/Country (outside US):
Zip/Postal Code:  *
 
 
Product Name:   Catalog #:   Lot #:
 
 
Order Date:
Test Dates:
Note: Enter dates in MM/DD/YYYY format. Use "," to separate multiple test dates.
Ordered from: ADI   Distributor (name): 
Were ALL reagents including TMB substrate
at room temp before and during the assay?		 Yes No
What reagents were diluted and how much:
Samples: Mouse   Rat   Human   Other 
Sample type: Serum   Plasma   Urine   Culture Medium   Other Sample Type 
 
How test samples were diluted and how much:
Has this product worked before? Yes   No  
Do you use automated washer? Yes   Number of washings 

What absorbance plates were read?

What were the Absorbance values of the standards?
Are you able to send the ELISA results printout? Yes   No

Describe how the assay was performed and nature of the problems: (no color, not enough color, etc)

Please enter any comments or special instructions :
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