BARROW-AGEE
LABORATORIES, LLC
1555 Three Place, Memphis, TN 38116-3507
SAMPLE SUBMISSION FORM
Customer Contact Information
Name:
Company:
Address:
City, State, Zip:
Phone:
Email:
Fax:
Additional Copies Sent to:
Billing Information
Name:
Company:
Address:
City, State, Zip:
Phone:
Email:
PO#:
Same As Above
Service
Fax:
Fees
Standard (5 Business Days)
Rush (2 Business Days-48 Hours)
Rush (1 Business Day-24 Hours)
Rush (Same Day-8 Hours)
Email Results
Fax Results
Return Sample(s)
Return Cooler
List Price
List Price + 100% Surcharge
List Price + 200% Surcharge
List Price + 300% Surcharge
No Charge
Shipping Acct. #:
Sample Identification
Analysis Requested
Specification
Example: Lot 25
Example: Moisture
Example: 5-10%
Special Instructions/Comments:
Results will be sent by email in PDF format unless otherwise instructed.
Ship samples with this form to: Barrow-Agee Laboratories, 1555 Three Place, Memphis, TN 38116-3507
Phone: (901) 332-1590  FAX (901) 398-1518  Email: Customerservice@balabs.com  www.balabs.com