Assayed Sample Sets Order Form

Enrollment Information

Enrollment Information

Identification Information

Identification Information
Current/previous account ID (if known)
If application in progress, enter "Pending"

Contact Information Of Person Completing This Form

Contact Information Of Person Completing This Form
Example: 123-456-7890

Shipping Information

Shipping Information

Fill in ONLY if new customer or information is different than PT enrollment.

Example: 123-456-7890

Billing Information

Billing Information
Example: 123-456-7890

Product Information

Product Information
VSPB - select instrument


Add Total Price Column
Enter $50.00 if express shipping is desired
Add Subtotal and Express Shipping (if applicable)

Payment Information

Payment Information


Verification

reCAPTCHA is required.
This step is to verify this form is being completed by a person and not a computer.

 

 

 

 

Contact WSLH Proficiency Testing | (800) 462-5261 | ptservice@slh.wisc.edu