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)
Fields marked with ** are REQUIRED!
** NUMBER of KITS   X $97 USD =  
Add $5 for handling on single-kit order ... total $102.00
>>> 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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Site design by:   Kenneth J Anderson & Associates       © 2003 - 2018 Nelco       Made with Xara 
Feb 03 2018 Mod
Our order form is now allowing you to press SUBMIT to send via e-mail.  Please contact us if any problems.