Order Form

If you do not find a distributor listed for your area or country, contact us directly for ordering assistance at info@trilliumdx.com.

To expedite your order, please complete and submit this form. Email is preferred, but the completed Order Form may also be printed and faxed to 1-207-942-0346.

We will contact you to confirm receipt of the order.

CODE NO.	REG. STATUS	PRODUCT	SIZE
QQF-100	RUO	FMH QuikQuant™	100 tests
QQH-50	RUO	FMH QuikQuant™: Hematology Analyzer Version	50 tests
* the QuikQuant kits are currently marked as RUO; FDA clearance is pending
FH-101	IVD	FETALtrol™ Blood Controls	2 sets of 3 levels/kit

HbF1-CFS	ASR	Anti-HbF Clone WBAC1: CFS or FITC (50 µg/mL)	1mL
HbF1-P	ASR	Anti-HbF Clone WBAC1: PE (25 µg/mL)	1mL
HbF1-U	ASR	Anti-HbF Clone WBAC1: Unconjugated (100 µg/mL)	1mL
PHb-P	ASR	Anti-pan Hb Clone: PE (25 µg/mL)	1mL
PHb-U	ASR	Anti-pan Hb Clone: Unconjugated (100 µg/mL)	1mL

LK-064-250	CE*	Leuko64™ Kit	250 tests
LK-064-75	CE*	Leuko64™ Kit	75 tests
LK-64H-100	CE*	Leuko64™ Hematology Analyzer Version Kit	100 tests
* the Leuko64 kits are CE marked as an IVD; FDA clearance is pending
CD64-22F	ASR	CD64 Clone 22: CFS (50 µg/mL)	1mL
CD64-22P	ASR	CD64 Clone 22: PE (25 µg/mL)	1mL
CD64-22Cy5	ASR	CD64 Clone 22: Cy5 (50 µg/mL)	1mL
CD64-22U	ASR	CD64 Clone 22: Unconjugated (100 µg/mL)	1mL

CD64-322F	ASR	CD64 Clone 32.2: CFS (50 µg/mL)	1mL
CD64-322P	ASR	CD64 Clone 32.2: PE (25 µg/mL)	1mL
CD64-322U	ASR	CD64 Clone 32.2: Unconjugated (100 µg/mL)	1mL

CD163-48F	ASR	CD163 Clone MAC2-48: CFS (50 µg/mL)	1mL
CD163-48P	ASR	CD163 Clone MAC2-48: PE (25 µg/mL)	1mL
CD163-48U	ASR	CD163 Clone MAC2-48: Unconjugated (100 µg/mL)	1mL

CD163-158F	ASR	CD163 Clone MAC2-158: CFS (50 µg/mL)	1mL
CD163-158P	ASR	CD163 Clone MAC2-158: PE (25 µg/mL)	1mL
CD163-158B	ASR	CD163 Clone MAC2-158: Biotinylated (25 µg/mL)	1mL
CD163-158U	ASR	CD163 Clone MAC2-158: Unconjugated (100 µg/mL)	1mL

CD163-R20P	ASR	CD163 Clone R20: PE (25 µg/mL)	1mL
CD163-R20B	ASR	CD163 Clone R20: Biotinylated (100 µg/mL)	1mL
CD163-R20U	ASR	CD163 Clone R20: Unconjugated (100 µg/mL)	1mL

MNDA-C31	RUO	Anti-MNDA Clone C31: FITC (50 µg/mL)	1mL

Macro163-E (IQP-383)	RUO	Macro163 kit: Soluble CD 163 ELISA kit	96 tests Std incl.
sTREM-1 (IQP-385)	RUO	sTREM-1 kit: Soluble TREM-1 ELISA kit	96 tests Std. Incl.

* = Required Field

Bill To:

Name*:
Organization:
Department:
Street Address:
City:
State:
Zip/Postal Code:
Country:
Phone:
Email*:
Purchase Order #:

Ship To:

Use Bill To Address?
Name:
Organization:
Department:
Street Address:
City:
State:
Zip/Postal Code:
Country:
Phone:
Email:
Purchase Order #: