Instant Testing Device Order Form

Please Note: This form is for current accounts. If you wish to set up a new account to order laboratory supplies please contact us at (800) 388-3204

CONTACT INFORMATION ** = required field

Company Name **

Email Address **

Address

City

State

Zip

Phone Number

Contact Name

ORDER DEVICE

Quantity

Urine Testing Cup, Oral Fluid Device and Dip Card with Cup come in units of 25. QED comes in units of 10.

Urine Testing Cup
Oral Fluid Device
Dip Card with Cup
QED

PANEL FOR TESTING

Select your panel below:

Other: Please specify which drugs you would like to test for:

 Once submitted, supplies may take up to seven business days to arrive. Please contact our office if supplies are needed any earlier.