Laboratory Supply Request

Collection and transport supplies are provided for a select number of tests. Please complete the information in the demographic section of the order form to ensure proper receipt of your supplies.

Please enter a quantity next to the supplies you wish to order. If you do not find the supplies you are looking for enter a quantity in the "Other" column at the bottom of the order form and describe the item you wish to order in the space provided.

For help ordering supplies please contact The Division of Microbiology at 701.328.6272 or email us at laboratory@nd.gov

Customer Code
Facility Name
Facility Address
Facility City
Facility State
Facility Zip Code
Submitted By
Phone
Email

Item RequestedQuantity
Each
Amies Transports: COA
Address Labels:
Abbott Chlamydia/GC Transport
Influenza Transports:
Ova & Parasite Transports:
Pertussis DNA Probe Transports:
Saboraud Fungus Transports: COA
Category B Shipping Boxes:
Tuberculosis Transports:
Viral Transport Media:
Quantiferon Collection Tubes:
Other: