the Gly-Tek testkit
How to Order the TestKit There are four ways to order your testkit(s): * E-mail Our online submittal option has recently been updated. Use the SUBMIT button at bottom; you will receive a confirmation e-mail if you have entered your own e-mail address. If any problems, 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) * PDF E-Mail Print filled-out form as PDF, send as attachment to e-mail on homepage * 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 $XXXX USD =  
Add $5 for handling on single-kit order ... total $XXXX
>>> 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?
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We currently do not accept credit cards.  An invoice will be sent to your company when your order is shipped. NOTICE OF NOV 1 PRICE INCREASE Effective Nov 1, 2020,  our price per testkit  will be $112.50 each;  a $5 single- kit  surcharge applies.
11/01/2020 Mod