Iowa State University Research Park
2711 South Loop Drive
Suite 4400
Ames, IA 50010
Purchase Order Form
P.O. Number
Contact & Company
Address
Phone Number
Email Address
Reason for assay (check box):
Sample Type (matrix):
Expected Conc. (research only):
Research
Diagnostic (CLIA)
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Test Type (fill in the blank with all that apply):
Test Requested#1_____________________________________________________________________
Test Requested#2_____________________________________________________________________
Test Requested#3_____________________________________________________________________
Test Requested#4_____________________________________________________________________
Test Requested#5_____________________________________________________________________
Additional Tests:______________________________________________________________________
List of all tests offered:
Acetate via HPLC
Amino acids via LC/MS/MS
ATP and metabolites via HPLC
ATP via HPLC
Creatinine via colorimetric Assay
BCKA via HPLC
DHEA via GCMS
HMB by GC/MS
Final disposition of samples post-assay (Check box) Dispose
HMB via HPLC
3-MH via GC/MS
3-MH via GC/MS (CLIA)
Creatinine via colorimetric assay (CLIA)
Return (include shipping acct to be billed)
Shipping Service: __________________________ Shipping Account#:____________________________
**We will retain samples for 30 days after final data has been reported**
**MUST include the sample manifest form with samples located online at www.mettechinc.com.**
** MUST also send an sample manifest form to the email below**
**Each test is volume specific please contact for requirements**
Signature: _____________________________________________ Date:____________________
515-296-9916 Office | 515-296-0908 Fax | email: rathmacher@mti-hmb.com | website: mettechinc.com