Sample Submission Form
Regulated Products
Printable Version
Customer Information
Company Name:
Contact:
Job Title:
Address 1:
Address 2:
City:
State:
Zip:
Phone:
Mobile:
Q Labs Proposal #:
Purchase Order #:
Details
Please check option(s) for receiving results (electronic documents will be in Adobe Acrobat (PDF) format).
Fax:
Email:
Mail:
Conduct of related study?: GLP
- GMP
- Other
Is this product filed for NDA or ANDA (or IND)?: Yes
No
Is this a Research & Development Project?: Yes
No
Turnaround time requested: Routine
Rush
Return Samples To Client?: Yes
No
Special Instructions:
Samples
#
Sample ID
Active
Test Name
Method
Validated
Specifications
1
Yes
No
2
Yes
No
3
Yes
No
4
Yes
No
5
Yes
No
6
Yes
No
7
Yes
No
8
Yes
No
9
Yes
No
10
Yes
No
11
Yes
No
12
Yes
No
Q Laboratories, Inc.
Address:
1400 Harrison Avenue Cincinnati, OH 45214 U.S.A.
| Phone:
(513).471.1300
| Fax:
(513).471.5600
| Email:
Office@QLaboratories.com
