Covid-19 Instant Test Order Request
Please fill out this order request form. Our finance department will contact you to collect payment and set up shipment. Please note, due to high demand, only fill out this form if you are ready to order.
Email address *
-100 Tests Per Case=$995.00 ($9.95/test)
-Ships Internationally: CE Marked
-10,000 MOQ for International Orders
Are you a new or existing customer? *
How many cases would you like to order? (100 test kits per case) *
Business Name *
Your answer
Contact info
Your name *
Your answer
Phone number *
Your answer
Shipping Address *
Your answer
Billing Address *
Your answer
Questions and comments
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