Fill out the Requisition Request Form below. A copy will be automatically sent to Qitek Labs. Requisition Request Account InformationAccount Name*Contact Name*Phone*Email* Address*City*State*Zip Code*RequisitionsToxicology (GEORGIA)# of Requisitions NeededPharmacogenomics (GEORGIA)# of Requisitions NeededPharmacogenomics (OKLAHOMA)# of Requisitions NeededMolecular Microbiology - RPP, EAR, UTI/STI, Wound# of Requisitions NeededNotificationsName 1 and Name 2 listed below will be notified with shipment information. Name 1Email 1 Name 2Email 2
