Standing Order: Legionella Sampling

Standing Order: Legionella Sampling
Aerobiology Client*
The information in this section will be used for communication to the Aerobiology client about the shipment of this standing order.
Name*

First NameLast Name
Email*
example@example.com
Phone Number*
Shipping Information: This address is for the physical receiving of supplies
Company Name*
Name*

First NameLast Name
Email*
example@example.com
Shipping Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Billing same as above

YesNo
Billing Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Supplies*

250 ml Bottles with Sodium Thiosulfate Product Image

250 ml Bottles with Sodium Thiosulfate1 bottle per sample location. Shipment includes a chain of custody and sampling protocol. Shipped in a box containing an insulated liner and packing inserts.

$ Free

Kits	Bottles
One kit
Two kits
Three kits

500 mL bottle, eachUse for ice machine samples. Individual bottles, comes in box with labels and COC.

$ Free Number of bottles

Start Date*

MonthDayYear
Date
Please check ANY months you DO NOT want to receive a kit:*

JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecemberNA
On What Date Would You Like to Receive Your Sampling Kit?*

On the 1st of the MonthOn the 15th of the MonthNo preferenceOther
If you need an item immediately, do NOT include it in the note section. Return to the AeroSTORE and place your order for immediate shipment.

Orders requested here will not be processed.

Return to the AeroSTORE and place your order for immediate shipment.
Notes:
Upload Custom Documents

EX: COC, sampling instructions
Cancelof
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