Client Supply Order Form Client Supply Order Form * - required fieldsRequestor Name* Client Name* Email* Address* Department* City* State*AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces PacificZip* Requisitions/PaperworkSurgicalSelect30 ea60 ea90 ea120 eaSexual HealthSelect30 ea60 ea90 ea120 eaGISelect30 ea60 ea90 ea120 eaHemeSelect30 ea60 ea90 ea120 eaMicrobiologySelect100200HospitalSelect100200Log SheetsSelect100200Specimen Log Sheets Specimen Log Sheets Surgical Tissue FixativesRPMI FixativeSelect1 ea2 ea3 ea4 ea5 ea - Formalin20sSelect1 box2 boxes3 boxes4 boxes5 boxes40sSelect1 box2 boxes3 boxes4 boxes5 boxes60sSelect1 box2 boxes3 boxes4 boxes5 boxes120sSelect1 box2 boxes3 boxes4 boxes5 boxes5 galSelect1 ea2 ea - Non-Gyn Cytology120 Saccomanno* (prefilled)Select1 ea2 ea3 ea4 ea5 ea6 ea7 ea8 ea9 ea10 eaCardboard Slide HoldersSelect510Reagent Alcohol (For Gout/Urine Cytology)Select399SlidesSelect369Transport Containers8ozSelect10 ea20 ea30 ea16ozSelect10 ea20 ea30 ea32ozSelect10 ea20 ea30 ea86ozSelect10 ea20 ea30 ea128oz (placenta)Select10 ea20 ea30 ea172ozSelect10 ea20 ea30 eaSmall Transport Bag (2in)Select1 pk2 pk3 pkParafilm (2in)Select2"4"ESNFDTSelect2"4"RenalSelect2"4" - KitsBone MarrowSelect51015RenalSelect369Small TransportSelect510CyPath® Lung KitSelect25101520 - Specimen Bags6x9 (standard size)Select100 ea200 ea300 ea400 ea500 ea8x10 (Ideal for 16oz and 32oz containers)Select50 ea100 ea12x15 (standard large size)Select50 ea100 eaMolecularAptima Multitest SwabSelect369Aptima Unisex SwabSelect369Aptima Urine Specimen CollectionSelect369GenProbe Unisex (Trichomonas Vaginalis)Select369HPV OnlySelect369HerpesSelect369Chlamydia/ Gonorrhea, M/F (Urine)Select369COPAN Swab (Bac.Vag/Yeast)Select51015COPAN ESwab (GBS)Select51015COVID-19 RT-PCR TestSelect510Small Transport KitSelect510Gyn CytologyThinPrep Vials (white)Select1 flats2 flats3 flats4 flats5 flatsThinPrep Collection Tools Select All ThinPrep Vials (white) ThinPrep Brushes/Spatulas ThinPrep Brooms Conventional Pap Only Other (Be specific) MicrobiologyDouble COPAN swabsSelect10 ea20 ea30 eaUrine collectionSelect10 ea20 ea30 eaSterile ContainersSelect10 ea20 eaViral Transport MediaSelect3 ea6 ea9 eaSpecimen Bags (6x9) (8x10) (12x15)Select10 ea20 eaMisc. Slides Other item (Be specific) Δ