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Get PPDL - 1 - W Physical Sample Submission Form - The Purdue Plant ... - Ppdl Purdue

) Office Use Only: Date received: Sample # Account No. 7/03 Date: Submitter s Name Client s Name Business Business Address Address City/State/Zip City/State/Zip County Fax ( Phone ( ) County ) Fax ( E-Mail Phone ( ) ) E-Mail Please include a check or money order (payable to Purdue University) for $11 per sample ($22 out-of-state clients). DO NOT SEND CASH. Additional charges for serological testing and diagnoses requiring exceptional amounts of time and resources may be ass.

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