enquiry form

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Please select the assays you are using? When not listed please fill out manufacturer and trade name. Do not fill out markers which are not applicable.
HBsAg
a-HCV, HCV-Ag
a-HIV, HIV-Ag
a-HTLV-1,a-HTLV-2
a-HBc
a-Trep.p.
Required volume (mls):
Preferred fill off volume (mls):
Name:
Department:
Institute:
Adress:
Postal code:
City:
Country:
Telephone number:
Telefax number:
e-mail:
VAT code (only EU countries)
Print this form and fax it to bioQControl. We will send an proposal within 10 working days.
Telephone: ++31-70-340.1670 Telefax: ++31-70-340.1671