Cellular Product Client Transport Kit
(Product Culture Bottles Not Included)
SUPPLY REQUEST FORM
Please fax this form to ViroMed Account Management at 336-436-1812 or
E-mail this form to ViroMed_AcctMgmt@LabCorp.com
LabCorp Account #: ____________________________
Ordered by: ___________________________________
Telephone #: _______________________________
Please complete the information below with your ship-to address:
Facility:
Attention:
Address:
City, State, Zip Code:
Supplies are routinely shipped via ground service to arrive 7 – 10 days following receipt of order. To request
overnight delivery, please provide the information below, and overnight charges will be billed to your air courier
account.
Air Courier: _________________________________ Account #: _________________________________
Authorization: _______________________________
QUANTITY
ITEM NAME
Cellular Product Client Transport Kit – (Transport Box Only – Bottles Not Included) - Each
ITEM #
38949G
(Please Note: The Cellular Product Client Transport Kit does not include BacT/ALERT SA Culture Bottles, BacT/ALERT SN Culture Bottles)
Transport Kit Contents:
Product sterility transport box, Foam interior cooler, Biohazard leak proof bag, Aqui-Pak 6-bay absorbent pouch, Ambient gel wrap, Red sealing tape, FedEx
UN3373 PAK large, FedEx Express Billable Stamp, FedEx Saturday delivery stickers, FedEx Yellow label, UN3373 Cat B label, and Transport kit
instructions.
Please order test request forms through your local LabCorp supplier.
If you have questions, please call ViroMed Account Management at 800-582-0077.
ViroMed Use Only:
Received by:____________________________________________ Received Date:____________________
Order #:_____________________ Entered by:_________________________ Entered Date: _____________
Revised April 15, 2014
Revised April 15, 2014