SAMPLE SUBMISSION FORM

 CLIENT DETAILS

 Client:______________________________________________________________________

Address:____________________________________________________________________

___________________________________________________________________________

Phone:______________________________________________________________________ 

Email:________________________________________________________________________

Contact:_____________________________________________________________

Date Shipped:________________________________________________________
 (Email microcb@aol.com prior to shipping)

 SAMPLE INFORMATION:

Product Designation:_____________________________________________________

Product Lot:____________________________________________________________

Quantity:_______________________________________________________________

Storage Conditions:______________________________________________________

Testing Required:_______________________________________________________

_____________________________________________________________________

Include Product Data Card / COA (needed for Protocol) 

Results Needed by:_____________________________________________________

 PO #_________________________________________________________________

PLEASE EMAIL ALL INFORMATION AND DO NOT INCLUDE IN PACKAGING.

COMMENTS:_____________________________________________________________________

_____________________________________________________________________

_____________________________________________________________________

_____________________________________________________________________

 _____________________________________________________________________

______________________________________________________________________

______________________________________________________________________