Supply Order Form

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Use the following guidelines when submitting this form:

  • Enter each visit-specific kit on a new line. It is imperative that the proper collection kit be identified and used for each visit.
  • A minimum of two (2) full business days for the receipt of supplies is required for all requests, including expedited orders.
  • Supplies are sent using the appropriate courier service.
  • For assistance, contact customer service.
Important Shipping Information
Standard Delivery:
Expect delivery within five (5) business days of the Order Date.
Expedited Delivery:
Specify the date supplies are required. Expedited orders may be subject to additional shipping fees, and may require Sponsor/CRO approval prior to shipment.
Expedited delivery date requested:
Client Information (required)
Specify the Protocol Number and Account Number exactly as they appear on the cover of the Investigator Manual.
Order Date  
Sponsor Company  
Protocol Number  
Account Number CT 
Investigator  
Order Placed By  
Phone Number  
Fax Number  
Email  
Kits
Specify the kit name exactly as it appears on the Fax Supply Order form, located in the appendix section of the Investigator Manual. If the requested kit is unclear, a representative will contact you.
Kit Name Quantity
Shipping Supplies
Specify the supply item exactly as it appears on the Fax Supply Order form, located in the appendix section of the Investigator Manual. If the requested supply is unclear or not approved for this study, a representative will contact you.
Description Quantity
Refrigerate Only Shipping Containers
(FedEx airbills included)		 5 lb/each
5 lb/case of 8
10 lb/each
10 lb/case of 6
Frozen (Dry Ice) Shipping Containers
(FedEx airbills included)		 5 lb/each
5 lb/case of 8
10 lb/each
10 lb/case of 6
Refrigerated/Frozen Shipping Container Sets
(FedEx airbills included)		 5 lb/each
5 lb/case of 3
10 lb/each
10 lb/case of 3
Other (specify):
Other (specify):
Other (specify):
To print a copy of this form for your records, scroll to the top and click Print Page.