MICROBIOLOGY DX, INC.

19A CROSBY DRIVE, STE 215

BEDFORD, MA 01730

TEL: 781-276-4956 FAX: 781-276-6236

ORDER PAD - FORMS AND SUPPLIES

Account Name:

Account Number:

Date:

How Many

Item Description

Supplied

CULTURETTE SWABS

EA

STERILE URINE CONTAINERS w/ BORIC

EA

STERILE URINE CONTAINERS
(no additive)

EA

MICROPLASMA/UREAPLASMA MEDIA

EA

SPUTUM COLLECTION KIT FOR AFB

EA

CHARCOAL SWABS

EA

VIRAL CULTURE SWAB

EA

YELLOW TOP BLOOD CULTURE TUBES

EA

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PLEASE ALLOW 2 BUSINESS DAYS FOR DELIVERY

QUANTITIES MAY BE RESTRICTED