Order form for GMO-Analysis

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

©2010 ScanBi Diagnostics AB • Box 166  •  Delivery: Växtskyddsvägen 3  •  Visit: Sundsvägen 14 • SE-230 53 Alnarp Sweden
Phone: +46 40 41 53 21  •  Fax: +46 40 41 55 44  •  E-mail: info@scanbi.se