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  Gene Check Product Order Form    
Fill out the form below to place your order for sample collection products.
Click "Submit" when complete.
  Tissue Collection: Amount:  
Ear Tag Applicator- $31.00
Ear Tag (tag in ear)- $3.25
Sample Only Applicator- $31.00
Sample Only Collector w/ Black Conical Punch Piece(no tag)- $2.75
Ear Tag Applicator Replacement Pin- $4.50
Sample Only Applicator Replacement Pin- $4.50
Extra Black Conical Punch Pieces- $0.15
Spring and Clip Repair Kit for Applicators- $4.50
Total:
  Blood Collection: Amount:  
EDTA Blood Tube (purple top)- $0.75
3cc Syringe- $0.75
Whatman FTA Card- $4.00
Total:
  Order Subtotal (S&H added at time of shipment):  
Shipping & Handling Notes:
 

Shipping charges will be added to the above subtotal at time of shipment. All orders are automatically shipped USPS and are subject to shipping and handling fees based on weight.

●Expedited shipping ( i.e. overnight or next day air) or use of FedEx or UPS is available upon request. To request special shipping, please provide instructions in the box below.

Orders placed before 11:00am MST will go out same day and orders placed after 11:00am MST will go out the very next business day.

   
  Special Instructions:    
     
Customer Information:    
*First Name:
*Last Name:
*Shipping Address:
*City:
*State/Province:
*Zip Code:
*Phone Number:
E-mail Address:
Billing Address(leave blank if same as shipping):    
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City:
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*Payment Options(Please place an "x" in one):    
Please call me for a credit card number once you receive my order.
Please Invoice me.
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