Customer Information

required fields *


Primary Contact*

Contact Email*

Contact Phone*

Is this order complimentary under a bioaugmentation culture purchase*

If Yes please enter the bioaugmentation number (e.g., KB-1-xxxx) provided on your complimentary Gene-Trac certificate

Requested Delivery Date* YYYY-MM-DD

Company Address*

Shipping Information

Please Ship to "Attention":

If different from above, please provide the shipping address

Order Details

Please select applicable tests and indicate the number of sample locations in each

Quotation Number (if you have one):

Test Choice 1:

Number of Samples:

Test Choice 2:

Number of Samples:

Test Choice 3:

Number of Samples:

Test Choice 4:

Number of Samples:

Test Choice 5:

Number of Samples:

Special Instructions

For sampling supply inquiries please contact:

Ximena Druar, B.Sc.
Direct: 519-515-0838