USP Media &#038; Supplies Order Form &#8211; US Micro Solutions

Enverify^TM Kits

Ordering Information

This form is for current customers of U.S. Micro-Solutions. If you are not a current customer, we will request additional information to create an account for you with this order.

Orders are shipped Priority Overnight.

You must have the sampling device (TSA contact plates/TSA paddles) that you normally use in your facility to perform the test. You may purchase contact plates from us if needed.
Are you a Current Customer?
Company Name
Phone Number

Area CodePhone Number
Email
example@example.com
Name

FirstLast
Address

Street Address

Street Address Line 2

CityState

Zip Code
Number of kits needed
Date needed

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
You must have TSA contact plates on-hand to complete this competency test. Do you need to order media ($25+shipping per 10-plate pack)?
Number of packs needed
Would you like to order the free Training Module on surface sample collection?
Please provide the additional requested information to create an account with your order.
Company Name
Principal Contact Name

First NameLast Name
Title
Principal Contact Phone Number

Area CodePhone Number
Principal Contact Address

Street Address

Street Address Line 2

CityState

Zip Code
Principal Contact Email
example@example.com
Is your Billing information different than your Principal Contact information?
Billing Name

First NameLast Name
Billing Phone Number

Area CodePhone Number
Billing Email
example@example.com
Billing Address (if different from Principal Contact address)

Street Address

Street Address Line 2

CityState

Zip Code
Is your Shipping address different than your Principal Contact address?
Shipping Address

Street Address

Street Address Line 2

CityState

Zip Code
Billing Preference
♦ Please call 724-853-4047 to provide a credit card number.
Number of kits needed
Date needed

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
You must have TSA contact plates on-hand to complete this competency test. Do you need to order media ($25+shipping per 10-plate pack)?
Number of packs needed
Would you like to order the free Training Module on surface sample collection?
Questions or Comments
Should be Empty:

EnverifyTM Kits

Ordering Information

Please provide the additional requested information to create an account with your order.

Enverify^TM Kits