Client Supply Order Form

Thanks for your continued business. You may complete this form and fax to Genetic Assays at (615) 781-0766 when supplies are needed. Please confirm inventory prior to submitting the order form. You can also order on-line at www.geneticassays.com.

For questions or comments, please call (615) 781-0709, or (800) 390-5280.

Company Name:	______________________________________________
Request Date:	______________________________________________
Requested By:	______________________________________________
Phone #:	______________________________________________
Fax #:	______________________________________________

Item	Qty.
GA Lab Request Form
FedEx shipping foms
Shipping container w/box (small)
Shipping container w/box (medium)
Shipping container w/box (large)
Cystic Fibrosis buccal swab collection kits
Paternity DNA test brochures
NAT/STD swabs (female)
Urine cups (sterile)
Digene cervical sampler brushes
Other:

We appreciate your business!