Drug Testing Order Form

Drug Testing Supply Order Form

Please note that the type of supplies sent will depend on individual contract agreements. Supplies that are not contractually agreed upon will be supplied at the charges listed.

Rush Shipping charges due to insufficient lead-time (2 weeks) for ordering supplies will be billed back to your account.

Supply usage in excess of submitted volume will be billed back to your account.

For non-contract clients, a $50.00 deposit is required for supply shipment. Minimum Testing charges is $100.00, if your testing charge is below $100.00 you will be automatically charged $100.00 Supplies needed for testing are included in the test price.

To Pay for testing please call Seth Wong at 303-287-9691 Thank you

First Name Last Name

Your Telephone Number

Your Email Address

Company Name

Shipping Address

City State Zip Code

Click on the Image for a Larger View

Sample cup (8 oz. Screw-top) $.50 ea. Qty

Collection cup (12 - 16 oz. Snap-lid) $.50 ea. Qty

Sample bag: 4 x 6 (Fitzco), heat-seal $.25 ea. Qty

                     Sandwich-sized zippered $.25 ea. Qty

                     6 x 8 (Fitzco), heat-seal $.30 ea. Qty

                     Quart-size zippered $.30 ea. Qty

                     8 x 12 (Kapak), heat-seal Qty

                     2 oz Whirl-Pak, write-on Qty

Blood tubes: Vacutainer, heparinized plasma separator $1.00 ea. Qty

                     plasma / serum transport tubes $.50 ea. Qty

Needles: 20 gauge, 1.5" length $.50 ea. Qty

Sharps Container: $20.00 ea. Qty

Sample Identification Tags: $.25 ea. Qty

Tamper-proof shipping cooler with lock, key and metal hasp $50.00 ea. Qty

Metal strip seal: $.10 ea. Qty

Evidence seal: Qty

Miscellaneous: Please Explain

Special Shipping Instructions

VETERINARY CHAIN OF CUSTODY FORM

You will be charged for any unused supplies