Request Supplies

Primary Account Details

Facility Name

Contact Name

Work Phone

Email

Address

Address Line 2

City

State

Zip Code

Shipping Information

Requested Delivery Date

Is your shipping address the same as your primary account address?

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Address

Address Line 2

City

State

Zip Code

Supply Quantities

SARS CoV 2 Testing Supplies (Test Swabs + Transport Media - 25 ct)

Genetic Testing Kit (20 ct)

FedEx Supplies (Shipping Labels & Clinical Paks - 20 ct)

UPS Supplies (Shipping Labels & Clinical Paks - 20 ct)

Miscellaneous

Additional Comments

Supplies will be shipped via ground, please allow 3-5 days for delivery. If you have questions regarding your order please contact Client Services at 877-202-7019.