the Gly-Tek testkit
How to Order the TestKit There are four ways to order your testkit(s):     * E-mail   (FIRST fill out this form, THEN print, scan, and e-mail as an attachment)     * 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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Site design by:   Kenneth J Anderson & Associates       © 2003 - 2017 Nelco       Made with Xara 
We’re having problems with the automatic processing of orders, and have removed the SUBMIT button.  You can fill out the form, print it, scan and attach to e-mail, or fax it, or mail it to us ... we hope to have this corrected soon!     (re-posted July 19, 2017)
After filling out the form, you can PRINT it, then either scan and attach the image to an e-mail (address on homepage)  OR fax it to us, OR send via postal mail.  We apologize for the inconvenience!