Mold Sample Form

Make sure you read the Testing Instructions Page before ordering!
Sample Submittal Form
 
First Name
Last Name
Street Address 1
Street Address 2
City
State
Zip
eMail Address
THIS IS THE EMAIL ADDRESS WE WILL SEND YOUR RESULTS TO, AND WE WILL ALSO USE IT TO MATCH YOUR PAYMENT INFORMATION WITH YOUR SAMPLES!

SAMPLE INFORMATION:
Below, copy the sample locations that you wrote on the samples you collected.

Sample One:
Sample Two:
Sample Three:
Sample Four:
Sample Five:

Using your browser's "print" command, print this page and include it with your samples and payment email.

Payment: After printing out this form, make sure you click the "PayPal add to cart" image below to pay for your samples.
The cost is $40 per sample.

The area below can be used as a mailing label. If you use it, cut it out and affix to your envelope by covering with scotch tape or clear package tape.

  Mold Testing Lab
9325 Seminole Blvd
Seminole, FL 33772