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 :


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 (Mexico), (USA) or give us a call at 805-922-0055 in USA, (667) 716-50-77 in Mexico.