ADDITIONAL KITS / MATERIAL ORDER FORM
FOR ASIA PACIFIC

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*Pharmaceutical Company:

*Requestor's First Name:

*Requestor's Last Name:

*Protocol Number:

Covance Project Number:

*Principal Investigator Name:

*Site Number:

*Country:

*Phone Number:

*Email Address:

*Confirm Email Address:

*Standard Delivery
Allow 8 working days for standard delivery for all countries except China and Japan. If you are located in an extended delivery area, your delivery may be longer.
Allow 22 working days for delivery for China.
Allow 10 working days for Japan.
Allow 20 working days for delivery for Japan for kit customization.

*Expedited Delivery
Expedited orders are subject to additional charge and may require Sponsor's approval prior to shipment.

Lab Kit
Please write the full visit name as noted in your Investigator Manual. Kits ordered may require Sponsor's approval prior to shipment.

Additional Bulk Supplies
Please describe the additional material you may need. Bulk supplies ordered may require Sponsor's approval prior to shipment.

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