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 - 2016 Nelco       Made with Xara  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!