Bionetix

Test Request/Sample Submission Form

I.

How would you like to receive results:

Email Mail Fax

Please choose one:

End-user Company Distributor Cortec/Bionetix

II.

Note: Microbial testing ranges from 24 to 48 hours. Total laboratory time is microbial testing time + 5-10 business days from date samples and all required information are received. Cortec will let you know if deadline is achievable or if alternative deadline will be required.

III.

IV.

YES / NO

V.

Sample ID Mfr Brand Dilution (%) pH Temp (C/F) Method Specification Add more

VI.

Sample ID Description of Sample Quantity Add more

Samples will be discarded 21 days after testing is complete.

Process of customer testing requisition:

Requisition sent -> Approved by lab -> Project # assigned -> Shipping instructions sent -> Samples arrive at Bionetix

-> Project started -> Customer/Employee notified of date of completion -> Report written -> Customer/Employee receives report.