— Buccal Collection Kit Reorder Form

Date Requested mm/dd/yy

Agency Requesting Kits

ORI

Person Requesting Kits

Delivery Point of Contact

Delivery Point of Contact Phone Number

Email Address

Shipping Address

Facility

Address Line 1

Address Line 2

City, State, ZIP Code

Number Of Kits Needed

50
100
200
300
500
1,000
Other

If "Other," please specify quantity (in multiples of 50)

Type of Kit Requested

Regular - Contains FD-936 for manual completion
Slim - Does not contain FD-936 for electronic data capture - See additional questions below

IF YOU REQUESTED "SLIM KITS," PLEASE SELECT AN OPTION BELOW

Consolidated Shipping Boxes (holds up to 70 completed and sealed DNA collection kits) For offices collecting at a minimum of 50 DNA samples per week. If selected, a single return shipping box should be ordered per 50 DNA collection kits ordered.

10
20
30
40
50
Other

If "Other," please specify quantity

Consolidated Shipping Mailers (holds up to 15 completed and sealed DNA collection kits) For offices collecting at a minimum of 10 DNA samples per week. If selected, 5 return shipping mailers should be ordered per 50 DNA collection kits ordered.

10
20
30
40
50
Other

If "Other," please specify quantity

Comments

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If you have any questions, please call (703) 632-7529

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Buccal Collection Kit Reorder Form

Buccal Collection Kit Reorder Form

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