ADDITIONAL KITS / MATERIAL ORDER FORM
FOR UNITED STATES, CANADA AND PUERTO RICO

Use this order form if you are requesting kits for United States, Canada and Puerto Rico. *Required Fields

IMPORTANT: PLEASE ENTER YOUR INFORMATION USING ONLY ENGLISH (ASCII/LATIN) CHARACTERS.

Please do not use Kanji, Cyrillic, or other non-English characters in your entry. A "Match the requested format" tag will appear indicating which field(s) need correcting. Thank you.
Section A
Remember my personal info for future forms.
A check or tick mark in this box will save you time in the future, when you request information from the Covance web site. A cookie file will be placed on your computer that allows our web site to auto-fill your commonly used name and contact fields on our forms.

If you wish to change any of the auto-fill information, simply type your new information over the previous auto-filled entry or entries on the form, and click the submit button. The previous information will be updated with the new.

If you do not want to use the auto-fill feature, or have a cookie placed on your computer, simply uncheck the box and the cookie information will be purged.

Please include all alpha/numeric characters.

Please include your Project Number!

This information can be found on the lower left hand corner of the kit requisition form, the lower left hand corner of the manual or laminated synopsis pages for your study.

The Project number contains 6 digits beginning with a 5.

Providing the Project number will help us process your order in a more timely manner

View Standard and Expedited Delivery Timeline Chart
  • Orders requiring Sponsor approval may extend the delivery date.
  • Due to regional holiday and transit schedules, actual delivery dates may be within 3 business days of the date indicated.


Please refer to chart for estimated delivery timelines.


Please refer to chart for estimated delivery timelines. Expedited orders incur an additional fee ($87.35 USD) and additional shipping and handling when applicable. Expedited shipments may require sponsor approval prior to order entry.

ATTENTION: DRY ICE ORDERS FOR NEXT DAY DELIVERY MUST BE ENTERED BY 3:00 PM EASTERN TIME. FOR PROTOCOLS REQUIRING SPONSOR APPROVAL FOR DRY ICE, ORDERS FOR NEXT-DAY DELIVERY MUST BE ENTERED BY 1:00 PM ET.

PLEASE ENTER "DRY ICE", THE DATE AND QUANTITY NEEDED IN THE COMMENTS SECTION AND MARK THE DELIVERY TYPE AS "EXPEDITED".

PLEASE NOTE: DRY ICE CAN BE REQUESTED IN ADVANCE AND IS ONLY DELIVERED TO SITES TUESDAY - FRIDAY.

SITES IN PUERTO RICO MUST CONTACT YOUR COURIER FOR DRY ICE AND SHIPPING SUPPLIES.

Section B
Remember my last order request (section B).
Checking this option will bring in the last order contents for each new order request.

If you do not want to use the auto-fill feature, or have a cookie placed on your computer, simply uncheck the box and the cookie information will be purged.

Lab Kit

The correct Visit/Kit name can be found on the "Visit Schedule" in the investigator manual or on the side of the kit box. This will help ensure that the items requested match what is in the database.

Please write the full visit name as noted in your Investigator Manual. Kits ordered may require Sponsor's approval prior to shipment.
 
 
Quantity
Reason
1.  

Expired   Lost   Insufficient Quantity   Other
2.  

Expired   Lost   Insufficient Quantity   Other
3.  

Expired   Lost   Insufficient Quantity   Other
4.  

Expired   Lost   Insufficient Quantity   Other
5.  

Expired   Lost   Insufficient Quantity   Other
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Additional Bulk Supplies
Please describe the additional material you may need. Bulk supplies ordered may require Sponsor's approval prior to shipment. Items not in the protocol will require approval.

 
Quantity
1.
2.
3.
4.
5.
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Shipping Boxes






Ambient   Frozen
Refrigerated   None  
Quantity





Other:

Shipping Documents




Other:
Quantity




PLEASE ENTER DRY ICE ORDER INFORMATION IN THE COMMENTS BOX BELOW. ADJUSTMENTS CAN BE MADE BY LISTING THE KIT/VISIT NAME AND THE QUANTITY ON HAND IN THIS BOX. ALSO, PLEASE LIST ANY SPECIAL INSTRUCTIONS NEEDED TO PROCESS THE REQUEST.

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