Payment Method: Visa  MasterCard   

Credit cardholder's name:_______________________________________________ 

Credit card # _________________________

Expiry date _________   
 

Order Information:   Date _________  Preferred currency      US$   CAD$
First Name
Last Name
EIN / VAT #
Organization/Business
E-Mail Address
Purchase Order
Address 1
Address 2
City _____________________	State/Prov.______________	Country___________________________
Telephone ________________ Fax ____________________  Postal Code _______________________

RAPID TESTS

Pricing:  $27.50 Canadian Dollars per Test PLUS SHIPPING

Number of Test Strips Ordered:

PSP: _____ Tests       ASP: ______ Tests        DSP: _______ Tests   

Application:  Lab ______      Field ______

Extraction Method for Sample Preparation:

PSP Tests:  AOAC _____  Rapid _____  Phytoplankton _____

ASP Tests:  AOAC _____  Rapid _____  Methanol _____ Phytoplankton _____                  

DSP Tests:  Methanol _____

EXTRACTION KITS and consumables available upon request