ADDITIONAL KITS / MATERIAL ORDER FORM
对于美国,加拿大和波多黎各

Use this order form if you are requesting kits for United States, Canada and Puerto Rico.*Required Fields

重要提示:请仅使用英语(ASCII / LATIN)字符输入您的信息。

请勿在条目中使用Kanji,Cyrillic或其他非英语字符。一种 ”匹配请求的格式" tag will appear indicating which field(s) need correcting. Thank you.
A部分
Remember my personal info for future forms.
当您从Covance网站申请信息时,此框中的支票或刻度标记将节省您的时间。Cookie文件将放在您的计算机上,允许我们的网站auto-fill您的表单上的常用名称和联系人字段。

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, simplyuncheckthe box and the cookie information will be purged.

Please include all alpha/numeric characters.

Please include your Project Number!

This information can be found on the lower left hand corner of the kit requisition form, the lower left hand corner of the manual or laminated synopsis pages for your study.

项目编号包含6位以5开始的数字。

提供项目编号将帮助我们更及时地处理您的订单

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.

ATTENTION: DRY ICE ORDERS FOR NEXT DAY DELIVERY MUST BE ENTERED BY 3:00 PM EASTERN TIME. FOR PROTOCOLS REQUIRING SPONSOR APPROVAL FOR DRY ICE, ORDERS FOR NEXT-DAY DELIVERY MUST BE ENTERED BY 1:00 PM ET.

PLEASE ENTER "DRY ICE", THE DATE AND QUANTITY NEEDED IN THE COMMENTS SECTION AND MARK THE DELIVERY TYPE AS "EXPEDITED".

PLEASE NOTE: DRY ICE CAN BE REQUESTED IN ADVANCE AND IS ONLY DELIVERED TO SITES TUESDAY - FRIDAY.

B部分
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, simplyuncheckthe box and the cookie information will be purged.

Lab Kit

The correct Visit/Kit name can be found on the "Visit Schedule" in the investigator manual or on the side of the kit box. This will help ensure that the items requested match what is in the database.

Please write the full visit name as noted in your Investigator Manual. Kits ordered may require Sponsor's approval prior to shipment.
数量
原因
1.

Expired丢失的Insufficient QuantityOther
2.

Expired丢失的Insufficient QuantityOther
3.

Expired丢失的Insufficient QuantityOther
4.

Expired丢失的Insufficient QuantityOther
5.

Expired丢失的Insufficient QuantityOther
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Additional Bulk Supplies
请描述您可能需要的额外材料。批量耗材订购可能需要在发货前提起赞助商的批准。不在协议中的项目需要批准。

数量
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5.
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Shipping Boxes






AmbientFrozen
冷藏没有任何
数量





Other:

货运单据




Other:
数量




PLEASE ENTERDRY ICEORDER INFORMATION IN THE COMMENTS BOX BELOW.调整可以通过在此框中列出套件/访问名称和手头的数量来制作。此外,请列出任何SPECIAL INSTRUCTIONSNEEDED TO PROCESS THE REQUEST.

注释