First Name
Last Name
Street Address 1
Street Address 2
City
State	Zip
eMail Address
THIS IS THE EMAIL ADDRESS WE WILL SEND YOUR RESULTS TO, AND WE WILL ALSO USE IT TO MATCH YOUR PAYMENT INFORMATION WITH YOUR SAMPLES!
SAMPLE INFORMATION: Below, copy the sample locations that you wrote on the samples you collected.
Sample One:
Sample Two:
Sample Three:
Sample Four:
Sample Five:

Using your browser's "print" command, print this page and include it with your samples and payment.

Testing Fees:
Mycotoxin testing is available for $325.00 per sample; results are emailed to you 5-10 days after receipt of your samples.
FASTTRACK testing:
FASTTRACK: 24 hr. results: $650.00
FASTTRACK: 72 hr. results: $487.00

Payment: After printing out this form, use the links below to pay with VISA or MasterCard:

To Order STANDARD (5-10 day results) TESTING, click here.
To order 72 HR. FASTTRACK TESTING, click here.
To order 24 HR. FASTTRACK TESTING, click here.

The area below can be used as a mailing label. If you use it, cut it out and affix to your envelope by covering with scotch tape or clear package tape.