Address *

Street Address, not PO Box, please.

Address 1

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Contact Person *

First Name

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Phone *

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Fax

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Product Category *

Medical Drug

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Optional Tests

Check any optional tests you would like us to perform.

Endotoxin-specific (EU/mL or EU/device)

Non-endotoxin pyrogens (EEU/mL or EEU/device)

Positive Product Control (%)

When would you like to deliver your samples to us?

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DD

YYYY

How fast do you want your results? *

Standard (results available 3-5 business days from sample delivery)

Premium (results available 48 hours from sample delivery)

How should we deliver your results? *

Email (password-protected PDF)

Fax

Hard copy