Collectors | Harvest Labs

Collector Supplies Order Form

Practice Name (Account Name) *Required

Contact Person's Name *Required

Phone *Required

E-Mail *Required

Address *Required

Address Line 2

City *Required

State *Required

Zip *Required

Select Your Preferred Carrier *Required

Quantities Requested By Item

# of Shipping Boxes

# of Shipping Bags

# of Shipping Labels

# of Toxicology Requisition Forms

# of Clear Cups

# of Biohazard Bags

# of Pathology Requisition Forms

# of Oral Fluid Collection Devices

# of Metabolization Charts

# of "Don't Panic" Support Cards

# of Reams of Copy Paper

Printer Ink Request

Printer Make (HP, Brother, Epson, etc.)

Printer Model

# of Ink Cartridges

Special Instructions

Type The Word (Anti-Spam) *Required

Important Ordering Info

This form is for COLLECTOR supplies only and is available only to current collection partners only.
Please complete the form with the company information that corresponds to your account.
Please allow 5-7 business days to receive supply orders.
The number and type of supplies sent to your agency will depend upon your volume, contract, and/or agreements. A support representative will contact you if you select supplies that are not contractually agreed upon or supplies that exceed normal monthly volumes.

Sales, Support, & Supplies:

(888) 975-7447

Phone Hours:

Mon - Fri 8:00 AM - 5:00 PM CST

Fax: (888) 511-8293

Info@Harvest-Labs.com

Collector Supplies Order Form

Collectors Can Request Supplies Online

Collector Supplies Order Form

Important Ordering Info

Sales, Support, & Supplies:

Phone Hours:

Contact Information

Services

Employment

Providers

Patients

Compliance Partners