Mold Registration Form

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CUSTOMER INFORMATION

Email Address

First Name

Last Name

Primary Phone Number*

Test Address*

Street Address

City*

City

State*

Zip Code*

TEST INFORMATION

Test Kit Identification Number:*

Date Sample Collected*

Select Date ×

Sample Methods*

You can send up to three (3) samples to the laboratory for analysis, please select the samples collected. Standard Laboratory Results within 7 days, $40 lab fee per sample.

Settling Method*

Indoor Air

HVAC

Settling Sample Location:

ie: Kitchen, Bedroom...

location

Swab Sample Location:

ie: Kitchen, Bedroom...

location

Bulk Sample Location:

ie: Kitchen, Bedroom...

location

PAYMENT

Express Lab Results

Results within 3 business days

add $20 per sample

Standard Mold Lab Fees

$40 per sample

$ 0

Add-ons

$ 0

Total

$ 0

Payment Method*

Credit Card (Paypal)

Pay through PayPal

You will be redirected to PayPal checkout page once you submit. After you complete your payment, you will be redirected back to our site with a confirmation.

Mold Registration Form

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CUSTOMER INFORMATION

TEST INFORMATION

Indoor Settling Sample

Outdoor Settling Sample

Visual Surface (Swab)

Bulk

PAYMENT

Pay through PayPal

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