ORDER FORM

PLEASE ALLOW A MINIMUM 2 WEEKS LEAD TIME FOR ALL ORDERS
Medical & Clinical Consortium
13740 East Nelson Avenue
City of Industry, CA 91746-2048
Tel:626-934-9364
Toll Free: 877.622.8378

 

 
Note: If you do not find the combination you are looking for, please contact the Office. FORM
*REQUIRED
 
*DATE:   *P.O. NUMBER: *ORDERED BY:
 
*BILL TO: *ADDRESS:
 
*CITY: *STATE:
*ZIP:
 
*PHONE:
FAX:
EMAIL:
 
Please indicate Method of Payment:
Payment with Credit Card
  
Other
***You will be notified when your your order is received. Your Credit Card information will be attained at that time.
 
SHIP TO: SHIP VIA CARRIER: (Distributors must fill-in to ship to your customer via UPS, FEDEX, etc.)  
SHIPPING COMPANY:
YOUR SHIPPER ACCOUNT NO:
 
SHIP TO: (UPS will not ship to a P.O.Box) PHONE: FAX:
 
ADDRESS:   COMMERCIAL BLDG: RESIDENCE:
 
CITY: STATE:
ZIP:
 

*For Special Orders, Extra Lead-Time is Required and Minimum Quantities Apply.

Single Tests
Single Tests Choose Cassette or Dipcard Item Number
Cassette  
Min. Qty
  Assay
Qty Ord
  
1301  
50
   Amphetamines
 
1302  
50
   Barbiturates
 
1303  
50
   Benzodiazepines
 
1304  
50
   Cocaine
 
1305  
50
   Marijuana
 
1306  
50
   Methamphetamines
 
1307  
50
   Opiates
 
1308  
50
   Phencyclidine
 
1311  
50
   Methadone
 
1312  
50
   MDMA ”Ecstasy”
 
               
Dip Card Tests
Ca-Dip & Dip Cards Choose Ca-Dip or Dip Card Item Number
Dip Card  
Min. Qty
  Assay
Qty Ord
  
1101  
50
   Amphetamines
 
1102  
50
   Barbiturates
 
1103  
50
   Benzodiazepines
 
1104  
50
   Cocaine
 
1105  
50
   Marijuana
 
1106  
50
   Methamphetamines
 
1107  
50
   Opiates
 
1108  
50
   Phencyclidine
 
1111  
50
   Methadone
 
1112  
50
   MDMA ”Ecstasy”
 
               
               
 
Ca-Dip
Ca-Dip & Dip Cards Choose Ca-Dip or Dip Card Item Number
Ca-Dip  
Min. Qty
  Assay
Qty Ord
  
2301  
50
   COC ,THC
 
2302  
50
   M-AMP, THC
 
3301  
50
   COC ,THC, M-AMP
 
3303  
50
   COC, THC, OPI
 
3303  
50
   COC, THC, AMP
 
4301  
50
   M-AMP, COC, THC, OPI
 
5301  
50
   COC, AMP, M-AMP, THC, OPI
 
5302  
50
   COC, M-AMP, THC, OPI, PCP
 
5303  
50
   COC, AMP, THC, OPI, PCP
 
   
50
   COC, AMP, M-AMP, THC, OPI, PCP
 
   
50
   COC,AMP,M-AMP,THC,OPI,PCP,BAR,BZO
 
   
50
   COC,AMP,M-AMP,THC,MTD,OPI,PCP,BAR,BZO
 
   
50
   COC,AMP,M-AMP,THC,MTD,OPI,PCP,BAR,BZO,MDMA
 
               
Dip Card Tests
Choose Dip Card Tests Item Number
Dip Cards  
Min. Qty
  Assay
Qty Ord
  
2101  
50
   COC ,THC
 
2102  
50
   M-AMP, THC
 
3101  
50
   COC ,THC, M-AMP
 
3102  
50
   COC, THC, OPI
 
3103  
50
   COC, THC, AMP
 
4101  
50
   M-AMP, COC, THC, OPI
 
5101  
50
   COC, AMP, M-AMP, THC, OPI
 
5102  
50
   COC, M-AMP, THC, OPI, PCP
 
5103  
50
   COC, AMP, THC, OPI, PCP
 
6101  
50
   COC, AMP, M-AMP, THC, OPI, PCP
 
8101  
50
   COC,AMP,M-AMP,THC,OPI,PCP,BAR,BZO
 
9102  
50
   COC,AMP,M-AMP,THC,MTD,OPI,PCP,BAR,BZO
 
10101  
50
   COC,AMP,M-AMP,THC,MTD,OPI,PCP,BAR,BZO,MDMA
 
               
               
 
Lab Ready Cup - All in one device
Lab Ready Cup Choose Item Number
Lab Ready Cup  
Min. Qty
 
Qty Ord
  
5701   50 5 Panel - AMP, COC, THC, M-AMP, OPI  
5702   50 5 Panel - COC, THC, M-AMP, OPI, PCP  
5703  
50
 5 Panel - AMP, COC, THC, OPI, PCP
 
5704  
50
 5 Panel - AMP, BAR, BZO, COC, THC
 
6701  
50
 6 Panel - AMP, COC, THC, M-AMP, OPI, PCP
 
7701  
50
 7 Panel - BAR, BZO, COC, THC, M-AMP, OPI, PCP
 
8701  
50
 8 Panel - AMP, BAR, BZO, COC, THC, M-AMP, OPI, PCP
 
             
 
Food Test Kits (Testing for prepared foods, surfaces and water)
Additional Items Choose Item Number
Item #  
Min. Qty
 
Qty Ord
  
5601   50 Swipe Test Kit - 3 ea. - COC, THC, M-AMP, OPI, PCP Contains 1-Spray, 1-Buffer and Insert.  
9991  
24
 Food Test Kit - 12 E-Coli, 12 Salmonella, Buffer and insert
 
9981  
25
 E-Coli Test - Tube - 25 test strips per tube w/buffer and insert
 
9982  
25
 Salmonella Test - Tube - 25 test strips per tube w/buffer and insert
 
9983  
25
 E-Coli Test - Single Test - 25 individually pouched test strips w/ buffer and insert
 
9984  
25
 Salmonella - Single Test - 25 individually pouched test strips w/ buffer and insert
 
             
 
Other Items
Additional Items Choose Item Number
Item #  
Min. Qty
   
Qty Ord
  
9930  
50
 MCC SALIVA ALCOHOL TEST (1 PER POUCH)
 
9931  
50
 MCC SALIVA ALCOHOL TEST (25 PER TUBE)
 
9902   50 MCC URINE ADULTERATION STRIPS (25 PER TUBE)  
9903   50 MCC URINE ADULTERATION STRIPS (POUCHED) - 25 PER BOX    
9914  
50
 SPECIMEN CUP W/SCREW LID & TEMP STRIP. (AVAIL. W/TEST ONLY)
 
9916  
50
 SPECIMEN CUP (STERILE) W/SCREW LID & TEMP STRIP. (AVAIL. W/TEST ONLY)
 
               
               
               
SHIPPING & HANDLING CHARGES APPLY AND WILL BE ADDED TO YOUR ORDER.