Lab Code Request Form

Principal Investigator / Lab Head Information

Laboratory Address

Billing Contact

This person may be someone in your lab or accounts payable office, and will only be contacted if there are problems or questions regarding the billing or payment for your order. If you will be using purchase orders, please provide the email address to which formal invoices should be sent!

Billing Address

If you will be using purchase orders, please provide the billing address that should appear on the formal invoice for your orders. If you are unsure, please consult your purchasing office before submitting your request!