Sample Submission - Pharmacy Initiative 3 Limited

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Email*
Name*
First Last
This is the name that will appear on the Certificate Of Analysis
Job Title*
Would you like to add additional email addresses for results to be sent to?
- Yes
Secondary Email*
Secondary Email
Secondary Email
Secondary Email
Secondary Email

Company*

This is the name that will appear on the Certificate Of Analysis
Address 1*

The hard copy of the Certificate Of Analysis will be posted to this address
Address 2
Address 3
Postcode/ZIP*
Country*

Direct Line*
General Company Line
Mobile

Do you have a valid quote for these submissions? *
Valid quote*
- Yes
- No
Please input the Pharmacy Initiative 3 Limited Quotation Reference here*

The reference appears at the top right-hand corner of your quotation
We will use the information that you provide on this Sample Submission Form to generate a quotation for you and this will follow by email, usually within 48 hours

Please provide your Purchase Order reference *
Purchase Order*

A Purchase Order form is required prior to release of analysis results

What turnaround time do you require? Please select *

Standard turn-around time is 10 working days from receipt of samples & paperwork. Shorter turn-around times must be agreed in advance and are subject to surcharge.
Turnround time*
- Standard
- 5 day
- 3 day

Do you require the analysis to be GMP compliant?*
- Yes
- No
Good Manufacturing Practice. By selecting yes, you authorise BLL to perform an investigation if out of specification (OOS) results are obtained. Additional charges may apply.

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If you experience any technical difficulties whilst completing this form, just email labsupport@pharminitiative-3.com for assistance.

If you would like to fill in a word document of this form please click here.