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Submit a procurement request.
Approved requests are invoiced. Payment via ACH/wire.
First name
*
Last name
*
Email
*
Phone
*
Multi-line address
Country/Region
*
Address
*
City
*
Zip / Postal code
*
Product(s) requested
*
Quantity per item
*
Notes
Compliance Certification (Check all boxes to acknowledge compliance)
*
For In vitro laboratory research use only
Not for human use
Not for animal use
Not for diagnostic use
Not for therapeutic use
Not for resale or redistribution
Signature
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Date
*
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Day
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