Order form

Customer
Company:		Contact person:
Address:		E-mail:
Zipcode:		Telephone:
City:		Fax:
Country:		Customer no:
Order date:		VAT number:

Analysis report adress (if other than customer)
Company:		Contact person:
Address:		E-mail:
Zipcode:		Telephone:
City:		Fax:
Country:		Customer no:
Order date:		VAT number:

Invoice address (if other than customer)
Company:		Contact person:
Address:		E-mail:
Zipcode:		Telephone:
City:		Fax:
Country:		Customer no:
Order date:		VAT number:

Shipping
Shipped by:		Departure time:
Tracking no:		Expected arrival time:

Comments, Please contact us incase you need a fast answer!

Sample ID:	Comments		Requested analysis
									Quantify if positive
									Quantify if positive
									Quantify if positive
									Quantify if positive
									Quantify if positive
									Quantify if positive
									Quantify if positive
									Quantify if positive
									Quantify if positive
									Quantify if positive
									Quantify if positive
									Quantify if positive

©2012 ScanBi Diagnostics AB Box 166  •  Visit/Delivery: Elevenborgsvägen 2 SE-230 53 Alnarp Sweden  •  Phone: +46 40 69 28 001
E-mail: order@scanbidiagnostics.com