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    On-line Ordering

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              Company Name: 
    WOHL Comp or Visit No.: 
          Telephone Number: 
                Fax Number: 
             Customer Name: 
             Email Address: 
            Street Address: 
                      City: 
                     State: 
                  ZIP Code: 
    

    EQUIPMENT/MEDIA/SUPPLIES
    QUANTITY
    0 - 999
    DATE NEEDED
    MM/DD/YYYY
    Andersen air sampler
    Mixed cellulose ester cassettes
    AGI-30 with impingers
    Malt extract agar
    Malt extract agar w/NaCl
    Cornmeal agar
    Tryptic soy agar
    Blood agar
    Polyvinyl chloride cassettes
    Endotoxin free poly carbonate cassette
     (for air or dust sampling)
    Endotoxin free glass vial
      (for liquid or bulk sampling)
    Legionella kits
    WallChek Sampler
    Zefon Air-O-Cell Pump
    Filter Paper Wipes
    Swabs
    Air-O-Cells
    Other

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