Ferret Aleutian Disease Virus ELISA Test Order Form

 
Today’s Date
Name
Business Name, if applicable
Address
Apt. #
City
State
Zip/Postal Code
Country
Daytime Phone Number
Evening Phone Number
FAX
Email

 

Order Table
Sample 1. Ferret Name
Sample 2. Ferret Name
Sample 3. Ferret Name
Sample 4. Ferret Name
Sample 5. Ferret Name
Sample 6. Ferret Name
Sample 7. Ferret Name
Sample 8. Ferret Name
Sample 9. Ferret Name
Sample 10. Ferret Name
How Would You Prefer Your Results Reported? (select all that apply)
Mail Telephone Fax E-mail
 
Total # of Samples:
Cost per Test:  
Prices: $15.00 per test (saliva or blood). Print a blank version of this form and make multiple copies for more than 10 specimens sent at one time.
All Pennsylvania shipments
Add 6% sales tax
Total Cost:
ADV Tests must be pre-paid using MC or Visa only.
Credit Card: (check one)
MC VISA
 
Credit Card #
Expiration Date
Name on Card
   

Signature: ____________________________________________

(When ordering by credit card, you must sign this form after printing and prior to faxing or mailing to Avecon.)

Thank you for your order. We look forward to helping you.

 

You can mail your order to:
 
Avecon Diagnostics, Incorporated
501 Grouse Drive
P.O. Box 8
Bath, Pennsylvania 18014
U.S.A.