Sample Chain of Custody Form

Office Location:

Which Asbestex office are you submitting samples?

Customer Details:

Company Name (if applicable)

Full Name

Business or Residential Address

Phone Number

Email Address

This is where your results will be emailed

Sample Details:

Property address of where the sampling was conducted? (optional)

Which address the samples come from?

Please complete the below. Ensure your sample bags are individually numbered with permanent marker with your name or company name:

Loyalty Discount Offer:

Receive a 10% discount by leaving us a Google Review by clicking the Google image below. Once submitted, please advise reception or by phone (02) 9008 0499 and enter your coupon code on checkout to apply your discount. Please note all reviews are subject to verification. If a review cannot be verified, the discount may be reversed and the outstanding amount charged to the original payment method provided.

Payment and Turn Around Time:

Choose one option below for how fast you require your sample results. ENSURE YOU ADD THE QTY. OF HOW MANY SAMPLES YOU HAVE SUBMITTED

STANDARD TAT (Slowest)

4 Business Day TAT

$95.00 AUD Sample Quantity
Item subtotal:

PRIORITY TAT (Fast)

2 Business Day TAT

$130.00 AUD Sample Quantity
Item subtotal:

URGENT TAT (Fastest)

Next Business Day TAT

$150.00 AUD Sample Quantity
Item subtotal:

Enter coupon

Subtotal

Tax

Total

Signature

Time

Sample Chain of Custody

Choose one option below for how fast you require your sample results. ENSURE YOU ADD THE QTY. OF HOW MANY SAMPLES YOU HAVE SUBMITTED*

Choose one option below for how fast you require your sample results. ENSURE YOU ADD THE QTY. OF HOW MANY SAMPLES YOU HAVE SUBMITTED