Portamedic® Lab Kit Order Form

 
  Heritage Labs wants to make the process of ordering Lab Kits easy and painless  for you. Use the convenient order form below to order your Portamedic® Lab Kit items online. Or, you can also order Heritage Labs Lab Kits. 

After you submit your order, we'll email you a summary, then quickly process and ship your order to you.

Portamedic Lab Kit
asterisk (  *  ) indicates required field 
   

Company Billing Information
*  Bill to:
*  Location Name:
*  Email Address 
     (for verification):
*  Branch #:
Branch Manager:
*  City:
*  State:
*  Zip/Postal Code:
*  Country:
*  Phone Number:
Fax Number:

Shipping Information
*  Ship to:
*  Company Address:
*  City:
*  State:
*  Zip/Postal Code:
Attention (insert name):
*  Shipping Method:
*  Can you accept
palletized shipments?		             Yes               No
Kit Language?       English        Español

Special Comments
    or Instructions:

Lab Kit Type

Item

Quantity 
per Case

Select Number of Cases
(15 or less)

Specify Number of Cases
(if more than 15)

Heritage Labs 

Blood A1100 25

DBS /  Urine

A1101 25
Urine A1102 25
Urine A1103 50
Oral Fluid Kit  A1104 25
Oral Fluid Kit  A1105

50

Lab Requisition Form K1101    
           
Lab Kit Type Item Quantity 
per Case 		Select Number of Cases
(15 or less) 		Specify Number of Cases
(if more than 15)

Lab One 

Blood A1600 25
Blood A1601 50
Filter Paper / Urine A1602 25
Filter Paper / Urine A1603 50
Oral Fluid   A1604 25
Urine Examiner A1605 25
Urine Examiner A1606 50  
Lab Slips A1607    
           
Lab Kit Type Item Quantity 
per Case 		Select Number of Cases
(15 or less) 		Specify Number of Cases
(if more than 15)

DBS / Urine

 A1401 50

Urine

A1402 50

Lab Slips

A1403

    
           
Lab Kit Type Item Quantity 
per Case 		Select Number of Cases
(15 or less) 		Specify Number of Cases
(if more than 15)

 CRL

Blood A1200 25
Blood A1201 50
DBS / Urine A1202 25
DBS / Urine A1203 50
Urine A1204 25
Urine A1205 50
Oral Fluid A1206 25  
Lab Slips A1207  
           
 

        

Orders will be shipped via ground service unless you specify an alternate method above.

If you like, print this page. Fill it out and fax your order to:
 Heritage Labs - Order Entry Department
Fax: 913.393.0624

Heritage Labs, Inc.
Tel: 913.764.1045

Questions? Comments? Send us email!
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Heritage Labs, Inc.