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New Customer Request



First Name * Last Name *
 
Title Email Address *

Billing Address

Shipping Address    

Contact Name* Contact Name
Company Name * Company Name
Address * Address
City * City
State * State
Zip * Zip
County * County
Phone * Phone
Fax Fax

Billing Information
Name on Card:
Credit Card Type:
Credit Card Number:
Expiration: /
Verification Number:
Click Here if the Address on your Credit Card is different from your Billing Address.
Address:
City:
State:
Zip:

Additional Information


Include Me in all Labsco communications and promotional offers.


Tax Exempt? (If tax exempt, fax a copy of your exempt certificate to 502-364-1608. You will be charged tax until a valid exempt certificate is received.)


Is a purchase order required?
Business Type
Other:

Type of Practice
 Other:

Certified CLIA?
What complexity?

Any GPO or Buying Group affiliations?
Additional comments:

Copyright © 2012 Laboratory Supply Company, Inc. Terms of Use Privacy & Security Policy

On Friday 4/26/13, LABSCO will complete its annual inventory cycle count.  During this timeframe, order processing will be suspended and resume on Monday 4/29/13.  As it relates to drop ship items, they will continue to process as scheduled during this period.  Contact Customer Service with any questions or concerns.