Fill out the Collection Supply Request Form below. A copy will be automatically sent to Qitek Labs. Collection Supply Request Account InformationAccount Name*Contact Name*Phone*Email* Address*City*State*Zip Code*ShippingBiohazard Specimen Transport Bags (25 per Case)# of Cases NeededUPS Laboratory Pak Bags (10 per Case)# of Cases NeededBarcode Labels (300 Labels, 1 per Case)# of Cases Needed **Note: This item can only be ordered if Qitek Labs supplied a barcode label printer.Barcode Label Printer (1 per Case)# of Cases Needed **Note: This item is only provided by Qitek Labs under special conditions. Georgia Return Labels# of Georgia Return LabelsOklahoma Return Labels# of Oklahoma Return LabelsEquipmentLaptops# of Laptops NeededPrinters# of Printers NeededPrinter Ink Cartridges# of Cartridges NeededPrinter Ink Cartridges TypeList the Exact ModelPaper# of Reams NeededPPE (Only for Qitek Collectors)Small Gloves# of Boxes NeededMedium Gloves# of Boxes NeededLarge Gloves# of Boxes NeededExtra Large Gloves# of Boxes NeededDisinfecting Wipes# of Containers NeededHand Sanitizer# of Bottles NeededToxicologyUrine Cups (25 per Case)# of Cases NeededPharmacogenomicsBuccal Swabs (WITH BUFFER LIQUID, 25 per Case)# of Cases NeededHematology/ChemistryLavender Top Tube Kits (25 per Case)# of Cases Needed **Note: Each case includes enough 21G butterfly needles, tube holders, alcohol pads, cohesive bandage, cotton balls, tourniquets, and lavender top tubes for 25 specimens)Tiger Top Tube Kits (25 per Case)# of Cases Needed **Note: Each case includes enough 21G butterfly needles, tube holders, alcohol pads, cohesive bandage, cotton balls, tourniquets, and tiger top tubes for 25 specimens)Molecular Microbiology (RPP, UTI, Wound)Nasopharyngeal Swabs (RPP, 10 per Case)# of Cases NeededEar Swabs (Ear, 10 per Case)# of Cases NeededCups/Vacutainers with Boric Acid (UTI, 25 per Case)# of Cases NeededWound Swabs (Wound, 10 per Case)# of Cases NeededNotificationsName 1 and Name 2 listed below will be notified with shipment information.Name 1Email 1 Name 2Email 2
