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New Customer (Please enter all information.)
Returning Customer (Please fill in Items in red marked with a '*'.)
 
* Principal Investigator:
  University/Institute/Company:
  Department/Building:
  Street Address 1:
  Street Address 2:
  City:
  State/Province:
  Country:
  Zip Code:
  Phone Number:
  FAX Number:
* E-mail address:
* Type of Institution:
* Emory Account or Your Internal Reference Number:
   
* Billing Contact Person:
* Billing Address:
* Billing Phone Number:
* Billing/Ordering E-Mail:
     
* 1)
Analyte To Be Measured

# of Samples

Material

Species
 
Sex

Documentation File
  2)
Analyte To Be Measured

# of Samples

Material

Species
 
Sex

Documentation File
  3)
Analyte To Be Measured

# of Samples

Material  

Species
 
Sex

Documentation File
  4)
Analyte To Be Measured

# of Samples

Material  

Species
 
Sex

Documentation File
  5)
Analyte To Be Measured

# of Samples

Material  

Species
 
Sex

Documentation File
  6)
Analyte To Be Measured

# of Samples

Material  

Species
 
Sex

Documentation File
If you do not wish for samples to be discarded upon completion of the assay, they will be sent back to you at your expense. The Lab does not store samples.
* Do you want the samples returned after the data report is received? Yes No  
* If "YES" to above question, please supply Fed.Ex. billing account number:  

For more information, contact Ilana Garza at 404-727-9354.

Instructions on how to send samples (click here to download pdf file)