Transcription of Order Form Back - API Paperless Proficiency Testing
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Order Form Back - API Paperless Proficiency Testing
Send orders and payments to: Department 9526, Box 30516, Lansing, MI 48909-8016 800-333-0958 Fax: NumberHCO #LAP/CAP #COLA #API # (if applicable)___ ___ D ___ ___ ___ ___ ___ ___ ___Shipping InformationBilling InformationShipping ContactBilling ContactInstitution NameInstitution NameDepartmentDepartmentStreet Address (products cannot be shipped to a Box)Mailing AddressAddress 2 Address 2 CityStateZipCityStateZipPhone/Fax:Phone/ Fax:Email:Email:Send copies of reports to: (a copy will also be sent to the address above)Send additional copies of reports to: (attach a list if more than two)AttentionAttentionInstitution Name and AddressInstitution Name and AddressCityStateZipCityStateZipPhone/Fax :Phone/Fax:Email:Email:Quantity Unit PriceTotal$$ $$ $$ $$ $$ $$ $$ $$ $$ $$ $$ $$ $$ $$ $$ $$ $$ $$ *Additional Shipping Charges $*Call API for additional shipping costs if you are located in AK, PR or outside of the continental to: Department 9526, Box 30516, Lansing, MI 48909-8016 2019 Order FormInnovative Solutions.
CHEMISTRY HEMATOLOGY & COAGULATION (continued) MICROBIOLOGY (continued) 137 Alcohol $330 247 Hemochron Jr. ACT - LR $245 356 MRSA Culture $107
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