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
GAUZE PADS
PK/200
PAP-PAK
BX/25
THIN PREP PAP KIT
BX/25
FEMALE GENPROBES
BX/50
MALE GENPROBES
EA
ORANGE GLUCOLA 100G BOTTLE
EA
"BIOHAZARD" SPECIMEN BAGS
EA
BAND AIDS
EA
ALCOHOL PADS
BX/200
FORMALIN BOTTLES
EA
PRINT THIS FORM AND RETURN TO LABORATORY
PLEASE ALLOW 2 BUSINESS DAYS FOR DELIVERY
QUANTITIES MAY BE RESTRICTED