Toxicology Supply Request

Please request all supplies by 2 PM CST with a 3-day advance notice.
Allow 2-3 days for shipping

COURIER CLIENTS: Place your supply order one day prior to your pick up date.

Clinic Name*
Address*
Street Address Address Line 2 City State ZIP Code
Phone**
Requested Delivery Date*
MM slash DD slash YYYY
Submitted By*
Email*
Products
Collection Cup w/ vacutainer + tubes (no preservatives) (qtys. of 100 or less)
Urine Transfer Straws
Urine Hats
Hidden
Oral Swabs (supplied in limited amounts)
Hidden
Disinfecting Wipes
Gloves
(one box, indicate: S, M, L, XL)
Glove Size
Printing Materials
Printer Ink (Black)
Printer Ink (Magenta)
Integrated Label Paper (250 sheets per bundle)
Printer Paper
Packing Materials
BioBags (qtys. of 100)
Small FedEx Paks w/ Labels
UPS Paks w/ Labels
Hidden
Small FedEx Paks w/ labels
Number of FedEx Paks requested should match number of foil packs
Large FedEx Paks w/ labels
Small Foil Pack
Small Foil Pack is for 1-10 tubes
Large Foil Pack
Large Foil Pack for every 25 tubes
Ice Packs
Ice Packs
Please contact supplies@ildp.com with any questions.
Notes
Name
This field is for validation purposes and should be left unchanged.