Name of Person Ordering Supplies. First
** FIRST AND LAST NAME OF PERSON TO RECEIVE SUPPLIES MUST BE INCLUDED**
PHONE NUMBER OF PERSON ORDERING SUPPLIES:
DSI Account No:
Name of Company:
PLEASE PRINT LOCATION CODE IF REQUIRED ON CCF
SHIP TO INFORMATION:
(No P.O. Boxes: must have physical mailing address as Quest does not delivery to P. O. Boxes)
Check if your collection site (ship to information) is to be preprinted on the chain of custody form as the collection site location.
Split Sample Kits
Hair Testing Kits
Chains of Custody
HAIRTESTING (Non-DOT) - (Quest Only)
Fedex Airbills (For Onsite Collections Only)
For OVERNIGHT or 2-Day Shipping, please provide your FEDEX shipping account number: Your FedEx shipping acct. will be billed for this shipment.
Please only enter numbers in this field.
Select Special Shipping Method
FedEx Overnight Shipping
FedEx Two-Day Shipping