Laboratory Analysis Services Request Sheet
 
The fields marked with * are required

Company Info

 Spanish Version
*Company Name :
*Requested by : *Requested Date :
*Phone: Email :
Field Contact Name : Field Contact Phone :

Result Notification

 Fill in contact information for new company or update contact information for existing company

Microbiology :
*Name : *Phone : Fax : Email :
 

Residues :
*Name : *Phone : Fax : Email :


Comments / Notes
You can select Microbiology and Residues Services in the same Request Sheet
Laboratory :   *Office :

Sample Source
Grower :
Ranch :
Lot :
Acres :
Beds :
*City :
*State : Other (specify) :
*Country :

Service
Sample Date :
*Test Type : Other (specify) :  
*Product : Other (specify) :  
Product State :
Water Source :
*Sample Description :
Click "Fill Sample Description" to move the sample information into the Sample Description box. You can also include additional information if needed in this box.
You can select more than one analysis. If the one you need is not specified here, please select Other (specify) and write it in the blank space
*Analysis Type
   
# of samples :

You must click 'Add Sample Service' button for each service to be added
 
If You experience any troubles filling out this Request Sheet, Please reffer to the Customer's Service at servicioalcliente@primuslabs.com (Mexico), dispatchgroup@primuslabs.com (USA) or give us a call at 805-922-0055 in USA, (667) 716-50-77 in Mexico.