Samples to be sent to this address: SAMPLE SUBMISSION FORM Please complete both pages of this form IN FULL and place all documentation together on top of the samples for us to READING SCIENCE CENTRE (RSSL) immediately access upon opening the package WHITEKNIGHTS CAMPUS PEPPER LANE READING MISSING / INCORRECT INFORMATION COULD DELAY RESULTS BERKSHIRE RG6 6LA PURCHASE ORDER NUMBER: RSSL PROPOSAL Tel: 0118 918 4000 CRM/ NUMBER: Fax: 0118 986 8932 See quotation Email: CONTACT NAME: TELEPHONE NUMBER: This will be the person receiving the results JOB TITLE: EMAIL ADDRESS: HEALTH & SAFETY COMPANY: Please enclose an MSDS with all hazardous samples ADDRESS: Is the sample Hazardous? YES NO Please advise if invoicing i.e. Cytotoxic, Carcinogenic,Teratogenic, Hazard Class 3 address is different Pathogen, Biological Hazard, Corrosive etc. If yes, please specify …………………………… YES NO Is the substance a Controlled Drug? POSTCODE: Only tick if it is a controlled substance Schedule 1, 2 or 3 or a Category 1 precursor. YOUR REQUIREMENTS Please complete all sections Ambient Frozen -18˚C Frozen -80˚C Chilled +5˚C STORAGE CONDITIONS Standard 5 Working days 2 Working days ERS TURNAROUND TIME (10-15+ Days-as per quotation) 5 Day, 2 Day & ERS are available by prior arrangement only TICK HERE IF YOU REQUIRE YOUR WORK TO BE DONE TO GMP Required by the pharmaceutical sector only. GMP rates apply. TICK HERE IF YOU REQUIRE YOUR SAMPLES TO BE RETURNED All samples are retained for 30 days before being disposed of or returned. Courier charges may apply. TICK HERE IF YOU REQUIRE MORE FOREIGN BODY JIFFY BAGS
SAMPLE SUBMISSION FORM Please complete both pages of this form IN FULL and place all documentation together on top of the samples for us to immediately access upon opening the package MISSING / INCORRECT INFORMATION COULD DELAY RESULTS Samples to be sent to this address: READING SCIENCE CENTRE (RSSL) WHITEKNIGHTS CAMPUS PEPPER LANE READING BERKSHIRE RG6 6LA Tel: 0118 918 4000 Fax: 0118 986 8932 Email: RSSL PROPOSAL NUMBER: See quotation CRM/ PURCHASE ORDER NUMBER: CONTACT NAME: This will be the person receiving the results TELEPHONE NUMBER: JOB TITLE: EMAIL ADDRESS: COMPANY: HEALTH & SAFETY Please enclose an MSDS with all hazardous samples ADDRESS: Please advise if invoicing address is different POSTCODE: Is the sample Hazardous? i.e. Cytotoxic, Carcinogenic,Teratogenic, Hazard Class 3 Pathogen, Biological Hazard, Corrosive etc. If yes, please specify …………………………… YES NO Is the substance a Controlled Drug? Only tick if it is a controlled substance Schedule 1, 2 or 3 or a Category 1 precursor. YES NO YOUR REQUIREMENTS Please complete all sections STORAGE CONDITIONS Ambient Chilled +5˚C Frozen -18˚C Frozen -80˚C TURNAROUND TIME 5 Day, 2 Day & ERS are available by prior arrangement only Standard (10-15+ Days-as per quotation) 5 Working days 2 Working days ERS TICK HERE IF YOU REQUIRE YOUR WORK TO BE DONE TO GMP Required by the pharmaceutical sector only. GMP rates apply. TICK HERE IF YOU REQUIRE YOUR SAMPLES TO BE RETURNED All samples are retained for 30 days before being disposed of or returned. Courier charges may apply. TICK HERE IF YOU REQUIRE MORE FOREIGN BODY JIFFY BAGS
General-sample-Submission-Form-NEW.docx