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					<p>Fill out your contact details and receive price quotes in your Inbox.</p>
					
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					<form action="xa/products/buy" method="post"  class="large odf_ajax">
	<input type="hidden" name="combo_id" value="6864">
<input type="hidden" name="product_id" value="2905">
<input type="hidden" name="product_title_text" value="CD274 (PD-L1, B7-H1) Monoclonal Antibody (MIH5), PE-Cyanine7, eBioscience™ (eBioscience)">
	<table class="key_value">
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							<th>
								<label for="1N1Z0q17437948742588">Product</label>
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							<td >
								<span >CD274 (PD-L1, B7-H1) Monoclonal Antibody (MIH5), PE-Cyanine7, eBioscience™ (eBioscience)</span>
							</td>
						</tr>
												<tr class="">
							<th>
								<label for="aj7Lus0l1743794874259">Your name</label>
																	<span class="required_input">*</span>
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								<input type="text" name="name" value="" placeholder="Your name">
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								<label for="e9x77mLJ17437948742592">Your E-mail</label>
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								<input type="text" name="email" value="" placeholder="Your E-mail">
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								<label for="ijXrAaQNI17437948742593">Your phone number</label>
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								<input type="text" name="phone" value="" placeholder="Your phone number">
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				<th></th>
				<td><button type="submit" class="btn btn-success btn-large">Submit</button></td>
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</form>
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