Submission Form

Client Information

Company

Contact

Address

Phone

Email Report To*

Relinquished By

Date

Time

Billing Information

Same as client

Company

Contact

Address

Phone

Email Report To*

PO #

RUSH Order (additional charges apply, contact us for details.)

Sample ID:

(i.e. Lot# - reflected on report)

Sample ID 1

Sample ID 2

Sample ID 3

Sample ID 4

Sample ID 5

Sample ID 6

Sample ID 7

Sample ID 8

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Sample ID 14

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Sample ID 16

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Sample ID 18

Sample ID 19

Sample ID 20

Sample ID 21

Sample ID 22

Sample ID 23

Sample ID 24

Sample ID 25

Sample Description:

Sample Description 1

Sample Description 2

Sample Description 3

Sample Description 4

Sample Description 5

Sample Description 6

Sample Description 7

Sample Description 8

Sample Description 9

Sample Description 10

Sample Description 11

Sample Description 12

Sample Description 13

Sample Description 14

Sample Description 15

Sample Description 16

Sample Description 17

Sample Description 18

Sample Description 19

Sample Description 20

Sample Description 21

Sample Description 22

Sample Description 23

Sample Description 24

Sample Description 25

Analysis Requested:

Analysis Requested 1

Analysis Requested 2

Analysis Requested 3

Analysis Requested 4

Analysis Requested 5

Analysis Requested 6

Analysis Requested 7

Analysis Requested 8

Analysis Requested 9

Analysis Requested 10

Analysis Requested 11

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Analysis Requested 14

Analysis Requested 15

Analysis Requested 16

Analysis Requested 17

Analysis Requested 18

Analysis Requested 19

Analysis Requested 20

Analysis Requested 21

Analysis Requested 22

Analysis Requested 23

Analysis Requested 24

Analysis Requested 25

LAL #

(Analyst Use Only)

LAL #1

LAL #2

LAL #3

LAL #4

LAL #5

LAL #6

LAL #7

LAL #8

LAL #9

LAL #10

LAL #11

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LAL #13

LAL #14

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LAL #16

LAL #17

LAL #18

LAL #19

LAL #20

LAL #21

LAL #22

LAL #23

LAL #24

LAL #25

Notes

For Lab Use Only

Price

Code

Report Date

Invoice #

Total

Invoice Date

Acceptable/Temp

Received By

Date

Time

This field should be left blank

Shipping Samples to Lipid Analytical Labs:

Provide samples in containers with a ‘smudge-free’ identification label and unique ID.
Use a courier (FedEx, UPS, DHL, etc.) and put ‘for research / lab analyses only’ in describing content(s), list the value of the package
as content worth $0.00.
Ship on a Monday-Wednesday to avoid hold up on weekends.
Email us the courier used and tracking number when available so LAL can track the sample(s) location.