Company Name Mailing Address by stw87072

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									                            AMERICAN SOCIETY OF CRIME LABORATORY DIRECTORS
                                            LABORATORY ACCREDITATION BOARD



                              APPLICATION FOR PROFICIENCY TEST PROVIDER


Company Name:

Mailing Address:



Contact Person:

Contact Title:

Telephone:                                              Fax:

E-Mail:

Billing Address (if different from above)                              A non-refundable
                                                               application fee of $500.00 will be
                                                                invoiced once ASCLD/LAB has
                                                           accepted the application and agreed
                                                                    to commence the
                                                                approval review process.

Please check the discipline(s) in which you are seeking to become an ASCLD/LAB approved
proficiency test provider:

           Controlled Substances                                    Toxicology
           Trace Evidence                                           Firearms/Toolmarks
           Biology                                                  Latent Prints
           Questioned Documents                                     Digital Evidence
           Crime Scene

List the specific test(s) for which you are seeking approval to distribute as an ASCLD/LAB
external proficiency test provider:




Signature/Date of Authorized Company Representative:

Submit application to:             ASCLD/LAB
                                   139J Technology Drive
                                   Garner, North Carolina 27529
                                   Attention: Quality Manager
                                   FAX: 919-773-2602

								
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