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
4 ML SERUM SEPARATOR
BX/100
3 ML LAVENDER TOP
BX/100
4.5 ML BLUE TOP
BX/100
6 ML RED TOP
EA
6 ML SERUM SEPARATOR
EA
10 ML SERUM SEPARATOR
EA
PRINT THIS FORM AND RETURN TO LABORATORY
PLEASE ALLOW 2 BUSINESS DAYS FOR DELIVERY
QUANTITIES MAY BE RESTRICTED