Login (or register as a new user) to have your form auto populate contact information. Submit Form Sample Submission Form Step 1 of 3 33% ID or Claim Number*Sample identification unique to the submitting company Sample Description*E.g. "Insect in bread product." Type of Testing Required*Please, provide a detailed description about your sample and your testing needs. Contact NameCompany Name* First Name* Last Name* Billing AddressStreet Address* Address Line 2 City* State* Zip* Shipping Address the Same?* Yes No Shipping AddressShipping Street Address* Shipping Address Line 2 Shipping City* Shipping State* Shipping Zip* Contact InformationPhone*FAXEmail* Required Turn-Around Time*Results will be reported within the specified time frame. Please, contact us for service pricing. Standard - 2 weeks max Premium - 1 week max Expedited - 24 hours max Do You Require A Shipping Kit?*A shipping kit is an insulated cooler that can be used to retrieve a sample. It includes ice packs/dry ice, detailed instructions, a return label, and a chain of custody document. NoYesPick Up Address*This is where the sample is to be retrieved. Return Service*Will the sample be returned to the shipping address when analysis is complete? Yes No Destroy After 30 Days Return Address*The sample will be returned to this address when analysis is complete. Would you like to register an account with us? Yes No Username*Please choose a unique username to log in with. Before submitting this form, please add the email address, info@cibotechlabs.com, to your contact list to insure delivery of your confirmation email. Password* Enter Password Confirm Password CAPTCHA
