ADDITIONAL KITS / MATERIAL ORDER FORM
FOR UNITED STATES, CANADA AND PUERTO RICO

Use this order form if you are requesting kits for United States, Canada and Puerto Rico. *Required Fields
Section A
Remember my personal info for future forms.
A check or tick mark in this box will save you time in the future, when you request information from the Covance web site. A cookie file will be placed on your computer that allows our web site to auto-fill your commonly used name and contact fields on our forms.

If you wish to change any of the auto-fill information, simply type your new information over the previous auto-filled entry or entries on the form, and click the submit button. The previous information will be updated with the new.

If you do not want to use the auto-fill feature, or have a cookie placed on your computer, simply uncheck the box and the cookie information will be purged.

Please include all alpha/numeric characters.

View Standard and Expedited Delivery Timeline Chart
  • Orders requiring Sponsor approval may extend the delivery date.
  • Due to regional holiday and transit schedules, actual delivery dates may be within 3 business days of the date indicated.


Please refer to chart for estimated delivery timelines.


Please refer to chart for estimated delivery timelines. Expedited orders incur an additional fee ($87.35 USD) and additional shipping and handling when applicable. Expedited shipments may require sponsor approval prior to order entry.

Section B
Remember my last order request (section B).
Checking this option will bring in the last order contents for each new order request.

If you do not want to use the auto-fill feature, or have a cookie placed on your computer, simply uncheck the box and the cookie information will be purged.

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

 
Quantity
Reason
1.

Expired   Lost   Insufficient Quantity   Other
2.

Expired   Lost   Insufficient Quantity   Other
3.

Expired   Lost   Insufficient Quantity   Other
4.

Expired   Lost   Insufficient Quantity   Other
5.

Expired   Lost   Insufficient Quantity   Other
Add additional row

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

 
Quantity
1.
2.
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4.
5.
Add additional row

Shipping Boxes






Ambient   Frozen   Refrigerated  
Quantity





Other:

Shipping Documents




Other:
Quantity




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