Microbial Source Tracking Sampling Kit Request Form
Please use this form to submit an order for sampling kits. MST Sampling kits contents include
-Plastic Cooler
-500 mL Sterile Sample Bottles
-Zip Bags for Bottles
-Ice Packs
-Packing Tape
-Chain of Custody Form https://sourcemolecular.com/wp-content/uploads/2018/08/Custody.pdf
-Sampling Recommendations and Packing Instructions http://sourcemolecular.com/send-samples/
If you have any questions, please call 786-220-0379.
Email address *
Company Name *
Your answer
Contact Name *
To whom should we address the shipment?
Your answer
Street (Ship to Address) *
Source Molecular uses FedEx Ground for shipments and cannot ship to a PO Box.
Your answer
City (Ship to Address)
Your answer
State (Ship to Address)
Your answer
Zip Code (Ship to Address)
Your answer
Contact Email *
Your answer
Contact Phone Number *
Your answer
Project Name
Your answer
Number of Bottles Requested *
Source Molecular's lab can analyze a single sample for multiple source-associated genetic markers. We need one sample for each location from which you want test results.
Your answer
Number of Coolers *
Source Molecular recommends a hold time of 24 to 48 hours from sample collection. Therefore, you should request a cooler per sampling event planned.
Your answer
Special Requests
Please let us know if you have any special requests for you kits.
Your answer
Estimated Sampling Date *
Source Molecular sends MST sampling kits via FedEx Ground and typically takes 1 week from order to delivery. If you anticipate needing kits for sampling to occur in less than 1 week, please call Source Molecular at 786-220-0379.
Your answer
Check this box if you need expedited delivery of your sampling supplies. Our standard shipping method is FedEx Ground. By checking this box, you agree to be invoiced for the expedited shipping charges.
Proposed Payment Method *
Test Limitations Statement (initial to acknowledge) *
Source Molecular Corporation’s (SMC) services are comprised of screenings for detectable levels of specific DNA fragments in samples furnished by you. Samples containing detectable levels indicate the presence of the particular bacterial/viral/parasitic strain associated with the specific DNA being tested. SMC uses screening methods and equipment that the scientific community considers to be reliable and effective. In performing services, SMC adheres to a rigorous quality control system that includes screening for false negatives and positives. However, SMC's tests are not infallible and numerous factors beyond SMC's control may affect the accuracy of testing, including, but not limited to: (a) poor sample collection by you; (b) improper handling and transportation of samples prior to their arrival at SMC's facility; (c) the idiosyncratic presence and absence of the bacterial/viral/parasitic strain being tested for from the gut of a particular animal; and (d) the idiosyncratic presence or absence of the particular DNA fragment being tested for from the genome of a particular bacterial/viral/parasitic colony. Due to such factors, SMC neither represents nor warrants that its tests will conclusively establish the presence or absence of bacterial/viral/parasitic contamination in a given water supply. You accept the limitations discussed herein and affirms your understanding that the most reliable way to accurately test for contamination is for you to increase its sample size and screen for a greater variety of DNA fragments.
Your answer
Pricing Statement (initial to acknowledge) *
Source Molecular reserves the right, at any time hereafter, to reduce or eliminate pricing discounts, and add additional fees as applicable, as a result of, and to offset, any legal costs associated with review/negotiation of your contract forms.
Your answer
Reporting Format (initial to acknowledge) *
Your sampling kit(s) include a Chain of Custody which will also serves as your analysis request form. Results are reported in a pdf file sent via email. Results can be reported in Presence/Absence or Quantification formats. Examples of the COC form and standard report formats are below. If you would like to discuss alterations to the report formats please call 786-220-0379. Chain of Custody form http://sourcemolecular.com/pdfs/custody.PDF Quantification Report http://sourcemolecular.com/pdfs/humanquant.pdf
Your answer
A copy of your responses will be emailed to the address you provided.
Never submit passwords through Google Forms.
This form was created inside of Source Molecular Corporation.