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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="8695">
<input type="hidden" name="product_id" value="5639">
<input type="hidden" name="product_title_text" value="Spectra™ Multicolor Low Range Protein Ladder (Thermo Fisher Scientific)">
	<table class="key_value">
		<tbody>
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							<th>
								<label for="WA75z7uB5o17436439266086">Product</label>
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							<td >
								<span >Spectra™ Multicolor Low Range Protein Ladder (Thermo Fisher Scientific)</span>
							</td>
						</tr>
												<tr class="">
							<th>
								<label for="FIZgrt0rV17436439266088">Your name</label>
																	<span class="required_input">*</span>
																							</th>
							<td >
								<input type="text" name="name" value="" placeholder="Your name">
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												<tr class="">
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								<label for="FGo51dhvg17436439266089">Your E-mail</label>
																	<span class="required_input">*</span>
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								<input type="text" name="email" value="" placeholder="Your E-mail">
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								<label for="l49glO91743643926609">Your phone number</label>
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								<input type="text" name="phone" value="" placeholder="Your phone number">
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									<tr>
				<th></th>
				<td><button type="submit" class="btn btn-success btn-large">Submit</button></td>
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</form>
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