Additional/Repeat EQA Samples Order Form Requested by: Date: Laboratory ID number or address Repeat samples: Distribution number Sample number(s) Quantity Total number of samples Additional Samples: Distribution number Sample number(s) Quantity Total number of samples Repeat samples will normally be sent with the next distribution. Only complete this section if you want to pay for earlier delivery. Invoice Address (if applicable) Customer Order No. VAT No. A limited number of repeat samples are available free of charge for participants who experienced technical difficulties with a distribution. Please return to: The Organisers, Public Health England, Food and Environmental Proficiency Testing Unit (FEPTU), 61 Colindale Ave, London, NW9 5EQ, UK. Fax: +44 (0) 20 8200 8264 E-mail: foodeqa@phe.gov.uk FEPTU105.01 Page 1 of 1