Request Information Form

(All fields marked with * are required)

What information do you need? (check all that apply)

 Product Information Request a Quote Evaluate a Sample Contract Manufacturing Assay Development Other (Please explain below)

Nature of Business of Your Company*

 Distributor/Reseller Research Institution NGO/Non profit OEM Reference Lab or Other Private Clinical Lab Public Health Lab Private Research Co. Manufacturer Other Type of Business (please explain below)

Which product(s) are you inquiring about?*

Intended Use of Product*

 Resell/Distribution Research Evaluation Sample Clinical Diagnostic Other Intended Use (please explain in space below)