Order Supplies | Harvest Labs

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

# of Shipping Boxes

# of Shipping Bags

# of Shipping Labels

# of Clear Cups

# of Oral Fluid Collection Devices

# of UTI Collection Kits

# of E-Swab Collection Devices

# of Biohazard Bags

# of Pathology Requisition Forms

# of Toxicology Requisition Forms

# of PCR Requisition Forms

Special Instructions

Type The Word (Anti-Spam) *Required

This form is for laboratory supplies only and is available only to current partners with an account number.
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 sales representative will contact you if you select supplies that are not contractually agreed upon or supplies that exceed normal monthly volumes.

(888) 975-7447

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

Fax: (888) 511-8293

Info@Harvest-Labs.com