the Gly-Tek testkit
How to Order the TestKit There are four ways to order your testkit(s): * E-mail Our online submittal option is not working reliably as of early June 2019, so we’ve temporarily disabled it. Please use one of the options below to order. * 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)
Fields marked with ** are REQUIRED!
** NUMBER of KITS   X $102 USD =  
Add $5 for handling on single-kit order ... total $107.00
>>> prices do not include shipping <<<


Buyer and Billing Information
** Buyer Name:
** Company:
** 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
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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June 2019 Mod
We currently do not accept credit cards.  An invoice will be sent to your company when your order is shipped. Price increase notice! Effective July 1st, 2019,  our price per testkit will  increase from $102 each to $107 each, $5 single- kit surcharge applies.
Please order by fax, mail, or phone as described at top of form. Our online ordering system is not available at this time