Sample Request

Free samples of some of our serum products are available for your evaluation.

Using the form below, you are able to request free samples.

If you would like to evaluate a sample of another serum product, please contact your Sales Representative at 1-877-716-6250.

Company Information:

 - required

 

Company Name:

Name of company that you are making a request for. 

Industry:

 

Website:

 

Fedex Account:

FEDEX account. All international shipments require the recipient's FEDEX account.

 

 

 

 

 

 

Contact Information:

 

 

First Name:

  

Phone:

Contact's primary phone number. FEDEX requires phone number of the recipient. Up to 15 characters are allowed in this field.

Last Name:

Last name of the contact. FEDEX requires last name of the recipient. Up to 50 characters are allowed in this field. 

Fax:

 

Title:

 

Email:

 

 

 

 

 

 

 

Address Information:

 

 

Shipping Street:

Primary mailing or shipping address of company.

Shipping City:

City portion of primary mailing or shipping address. Up to 40 characters are allowed in this field.

Zip/Postal Code:

Zip or postal code portion of primary mailing or shipping address. Up to 20 characters are allowed in this field.

Shipping State/Province:

State or province portion of primary mailing or shipping address. Up to 20 characters are allowed in this field.

Country:

Country portion of primary mailing or shipping address. Up to 40 characters are allowed in this field.

 

 

 

 

 

 

Request information:

 

 

Sample:

 

Quantity to reserve:

While testing our sample we will hold your needed quantity of serum until you have completed your testing. The minimum volume we are able to hold on reserve is 10 x 500ml.

Reserve period:

Our company usually holds serum for 3 weeks. If your application requires a longer testing period, please let us know at the time you make a reserve request.

Cell lines you are testing with:

 

Special Instructions:

 

 

 

 

 

 

 

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BIOTECHNICS RESEARCH, INC
toll free: 877 716 6250, email: sales@biotechnics-us.com