Order Laboratory Supplies Order Laboratory Supplies Please use this form to request supplies from PDL. Your Name *: Practice Name *: Full Practice Address *: Contact Phone *: Contact Email *: * = required field ------------------------------------------------------------------------------------------------------------------------ Item: ------------------------------------- Unit of Measure: -------- Qty Requested: Prefilled NBF, 15 ml ----------------------100/case: ----------------- Prefilled NBF, 20 ml ----------------------100/case: ----------------- Prefilled NBF, 40 ml ----------------------100/case: ----------------- Prefilled NBF, 60 ml ----------------------100/case: ----------------- Specimen Trap, 40 ml -------------------50/case: ------------------ Biopsy Pads (Blue)------------------------500/pk: ------------------- Slides-----------------------------------------50/bx: --------------------- Slide Holder (Holds 5 Slides)------------1/each: ------------------- Slide Holder (Holds 25 Slides)----------1/each: ------------------- Slide Holder (Holds 50 Slides)----------1/each: ------------------- Slide Holder (Holds 100 Slides)--------1/each: ------------------- Cytology Cups, 30 ml---------------------50/bx: -------------------- CytoLyt Cups, 50 ml----------------------50/case: ----------------- CytoLyt Cups, 80 ml----------------------50/case: ----------------- DIF Kit----------------------------------------1 each: ------------------ FNA Cytology Kit--------------------------1 each: ------------------- GYN Thinprep Tubes, 30 ml------------1 each: ------------------- Coplin Jars - Dry--------------------------1/each: ------------------- Coplin Jars - Wet ------------------------1/each: ------------------- Sterile Urine Cups------------------------1/each: ------------------- Dermatology Requisitions-------------100/pk: -------------------- Biohazard Transport Bags, 6 x 9-------500/bx: ----------------- Biohazard Transport Bags, 12 x 15----500/bx: ----------------- ------------------------------------------------------------------------------------------------------------------------ Word Verification: Please type the word verification here before submitting: