You must have JavaScript enabled to use this form. INSTRUCTIONSThis service request form must be fully completed for services to be performed. By submitting samples and completing this form, you agree to all terms and policies as outlined on our webpage (https://spscc.edu/tumwater-falls-lab), in our forms, and on our promotional materials. All information provided is held with the strictest confidence. Samples may need preparation prior to analysis and additional fees may apply. The client will be contacted to approve of any applicable fees before analysis is initiated. Client_Contact Name Company Email Phone This is the contact number lab staff will use to schedule a sample drop-off date and time. Address Address 2 City State - Select -AlabamaAlaskaAmerican SamoaArizonaArkansasArmed Forces (Canada, Europe, Africa, or Middle East)Armed Forces AmericasArmed Forces PacificCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFederated States of MicronesiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyomingAlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNova ScotiaNorthwest TerritoriesNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon ZIP Attention Contact Email for Reports Billing Contact Billing Contact Billing Email SERVICE REQUEST INFORMATION Samples must be clearly labeled and in good condition. See our webpage for more instructions. Be sure enough of each sample is sent for all desired services. PO/Request #: Service_Request_List Sample Name/Brand Service Requested Pkg Type/Size Notes Sample Name/Brand Service Requested/ Number Pkg Type/Size Lab Use Only Sample Name/Brand Service Requested/ Number Pkg Type/Size Lab Use Only Sample Name/Brand Service Requested/ Number Pkg Type/Size Lab Use Only Sample Name/Brand Service Requested/ Number Pkg Type/Size Lab Use Only Sample Name/Brand Service Requested/ Number Pkg Type/Size Lab Use Only All information provided above is used for reporting purposes. Samples should be clearly marked: “Samples for Analysis Only”
