Sample Submittal Form

Please fill out the form below or download the printable form and send to us.
Results To
Company*
Email*
Phone*
Fax
Address*
Street Address City Province Postal Code
Invoice To
- Same as Results
Company
Email
Phone
Fax
Address
Street Address City Province Postal Code
Info
Submitted By*
Project #
Date*
MM slash DD slash YYYY
Send Additional Copies To
Name Email
Sample Info
Analysis Requested*
# Samples Type of Sample Sample Sequence (from-to) Element or Package Priority Service (1.5x price)
Special Instructions
Storage & Disposal
Select One
- Return after analysis @cost
- Return after 3 months @cost
- Discard after 3 months @cost
- Paid storage after 3 months
- Pickup by sender
Note: Rejects and pulps will be disposed after 3 months unless requested. Charges will apply for disposal and storage of both pulps and rejects.
Return Address
- Same as Results
Company
Email
Phone
Fax
Address
Street Address City Province Postal Code
Authorization*
- I hereby approve the above information for processing.
Your Name*
CAPTCHA

Name	Email

# Samples	Type of Sample	Sample Sequence (from-to)	Element or Package	Priority Service (1.5x price)

Results To