Sample Reservation Form

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					                                              Quality Biological, Inc.

                                      Fetal Bovine Serum
                            Reservation and/or Sample Request Form


Date of Sample request: __________________ Sample Size: _____50ml ___ or 100ml

Type of FBS to Sample: ________ US Origin ______USDA approved for importation

How many different lots would you like to test? ______

Date sample needed in your facility: _________________

Number of bottles to be held in reserve from each lot while you test: _____________ (there is no fee to
reserve FBS and the reservation may be cancelled without penalty pending the results).

Approximate date your test will be completed: _____________________

What size bottle(s) will you purchase?                            100ml ______ 500ml _____ 1L ______

Please complete the shipping information below:

Name:_________________________________ Company/Institution ________________

Address: _______________________________ Address 2: _______________________

City: __________________ State _____ Zip Code: _____________

Telephone ___________________ Fax ________________________

Email___________________________________________________




                                            7581 Lindbergh Drive • Gaithersburg, MD 20879
                                   (301) 840-9331 •Toll Free (800) 443-9331 • Fax (301) 840-0743
                                Email: info@qualitybiological.com • Web Site: www.qualitybiological.com

				
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Description: Sample Reservation Form document sample