the Gly-Tek testkit
How to Order the TestKit There are four ways to order your testkit(s):     * E-mail  (Fill out this form, THEN click the SUBMIT button at bottom of the page; you will         receive a copy of your order via e-mail IF you have filled in your e-mail address.)     * Fax   (FIRST fill out this form, THEN print, fax to number on upper right of homepage)                * Regular Mail (FIRST fill out this form, THEN print 2 copies, mail ONE to address shown           in upper right corner of homepage, keep second copy for your records)           * Phone (call the number listed on upper right corner of homepage)  
Order Info (each KIT contains TEN tests)
Number of KITS   X $97 USD =  
Add $5 for handling on single-kit order ... total $102.00
>>> prices do not include shipping <<<

P.O. Number:

Buyer and Billing Information
             
Buyer Name:
Company:
Division:
Billing Address:
City, St/Prov, Zip/Code:    
Phone:   Fax:  
E-mail:
Shipping Method: Ground    Air    2nd Day Air

Fill below if DIFFERENT from billing address
Attention:
Division:
Shipping Address:
City, St/Prov, Zip/Code:    

If you would like a confirmation, how should we contact you?
   E-mail    Phone    US Mail    None needed

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