Welcome to OriCiro!

APPLICATION FOR A BUSINESS ACCOUNT WITH OriCiro Genomics

Below is a list of questions that you will be required to address when applying for a license of OriCiro Products. Please will fill in the blanks as accurate as possible. This information will be used assessing an approval and conditions of the license.

We will get back to you within 3 business day after your submission

Question Title

* 1. BUSINESS CONTACT INFORMATION

Contact name

Company name

Company address (Postal)

Street

City

State

Zip code

Country

e-mail

Phone number

Question Title

* 2. What is your business field?

Pharmaceuticals

Vaccine

Diagnostics

Plant

Cosmetics

Others (Detail)

Question Title

* 3. What is expected field of use?

For Research Use Only

For Research and a Commercial Use (Pharmaceuticals)

For Research and Commercial Use (Vaccine)

For Research and Commercial Use (Diagnostics)

Others(detail)

Question Title

* 4. What territory do you expect?

North America

Europe

South America

Asia (excludes Japan)

South East Asia

World Wide

Welcome to OriCiro!

APPLICATION FOR A BUSINESS ACCOUNT WITH OriCiro Genomics

Question Title

* 1. BUSINESS CONTACT INFORMATION

Question Title

* 2. What is your business field?

Question Title

* 3. What is expected field of use?

Question Title

* 4. What territory do you expect?

Question Title

* 5. Could you tell what type of application do you expect to apply this technology?