Energy Laboratories Inc.

Client Information

Name of Submitter/Contact:*

Date:*

What company are you with?*

Best contact phone number:*

Best contact email address?*

Do you require your work be done specifically at one of our locations?*

Do you require a data validation package other than standard?*

YesNo

Testing/Analysis Info

Project Name:*

Is this analysis for drinking water?*

YesNo

Will the samples be filtered in the field?*

YesNo

Do you have specific requested reporting needs?*

Yes - Contact a PM to ask for a quoteNo

Do you need tests run by a specific method?*

Yes - Contact a PM to ask for a quoteNo

Please list individual parameter needs:

Additional Information

The following pieces of information may be helpful to ensure a complete order. If applicable, please have available as you work with a Project Manager on your first order:

Testing Dates and Turn-Around-Time requests
Certification Requirements
Permit Requirements
PWS ID if Drinking Water is requested
Existing Quotes
Who the financial responsible party for results will be
Any Purchase Order information needed on the order
Special Reporting Formats
Distribution lists for reports and invoices
Shipping requirements (service level, return information) & addresses

New Order

Client Information

Testing/Analysis Info

Quote Information

Shipping/Receiving Information

Additional Information

Additional Information