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Non-Criminal Case Submission Form Bode Case No To be filled out by Bode This form must be sent along with the evidence samples and payment in order to process your case efficiently. For more information please call Technical Services at 866 263 - 3443 x 787 or e-mail bode. service bodetech. com* Primary Contact Telephone Address Email City Additional Contact Select the type of Service 10430 Furnace Rd. Suite 107 Lorton VA 22079 Phone 866-263-3443 Fax 703-646-9742 www. bodetech. com State Zip Investigative Service - Includes screening for bodily fluids DNA analysis and comparison of profiles for 1 item of evidence and up to 2 known samples per case for 1495. Contact Bode if you have additional items to submit for testing. Results within 6 - 8 weeks. Expedited Service -Investigative Service completed within 3 - 4 weeks 2 x standard pricing Please indicate how you would prefer to receive your results Select all that apply Mail 25 fee for Courier Fax Briefly describe the case background or the objective of the DNA testing that you would like completed List Evidence Items Submitted Evidence Return Address 25 fee for Couirier waived if mailed with report Payment must be received before DNA processing is initiated* Please select your payment preference Credit Card only VISA Mastercard or American Express Name on Card Security Code Billing Address Type of Card Card Number Address Line 2 Total Amount Exp* Date Check payable to Bode Technology is enclosed cashier s check certified check or money order accepted no personal checks Signature TERMS CONDITIONS Results are provided for investigative purposes only and cannot be used for public dissemination or in the court of law. The results are not intended for use in legal matters due to the lack of a chain of custody. Prepayment with all required paperwork is necessary prior to case initiation* Bode will perform DNA analysis to the best of our ability on the materials provided but cannot guarantee a result will be obtained in every case. All information and results are confidential* Bode will not disclose information to anyone other than the specified points of contact. I hereby certify that the information provided above is accurate to the best of my knowledge. I understand and accept the Terms Conditions listed above. Print Name Date Please submit this completed form with the evidence. All evidence items must be shipped to the following address Bode Technology ATTN EVIDENCE DEPARTMENT. For more information please call Technical Services at 866 263 - 3443 x 787 or e-mail bode. service bodetech. com* Primary Contact Telephone Address Email City Additional Contact Select the type of Service 10430 Furnace Rd. com* Primary Contact Telephone Address Email City Additional Contact Select the type of Service 10430 Furnace Rd. Suite 107 Lorton VA 22079 Phone 866-263-3443 Fax 703-646-9742 www. bodetech. com State Zip Investigative Service - Includes screening for bodily fluids DNA analysis and comparison of profiles for 1 item of evidence and up to 2 known samples per case for 1495.

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