FBI Laboratory
Buccal Collection Kit Re-Order Form

Please allow 2 weeks for delivery of collection kits.

Date Requested:
______________________________
Agency Requesting Kits:
______________________________
Person Requesting Kits:
______________________________
Number Of Kits Needed:
 50____   100____  150____   200____   Other____  (multiples of 50)
 
Number Of Additional Forms Needed:
______________________________

Note: An additional supply of forms equivalent to 10% of your total kit order will be included automatically

Shipping Address:
Facility:
______________________________
Address:
______________________________
Address:
______________________________
City:
______________________________
State, Zip Code:
______________________________
Phone Number:
______________________________
Fax:
______________________________
Point of Contact:
______________________________

PLEASE FAX YOUR REQUEST DIRECTLY TO
The FBI Laboratory
AT (703) 632-7620

IF YOU HAVE ANY QUESTIONS, PLEASE CALL (703) 632-7529

Official Use Only

Date Request Received:
______________________________
Request Approved By:
______________________________
FBI Release Number:
______________________________
Date Request Sent To Contractor:
______________________________