PHS-Eastwood Central Laboratory - Account Opening Form (Company and Site Details)
| Company Details | --------------------------------------------------------------------- | For PHS Use |
| Aims Member Name | ||
| Report to (e.g. Mr J.Smith) | ||
| Address L1 | ||
| Address L2 | ||
| Address L3 | ||
| Post Code | ||
| E-mail address (optional) | Use for Reports? Tick Here |__ |
|
| Contact telephone/fax | ||
| Abattoir Details | If different from above | |
| Name | ||
| Address L1 | ||
| Address L2 | ||
| Address L3 | ||
| Post Code | ||
| Sampling requirement - if known: | ||
| Planned start date____/_____/_______ Sampling Frequency ____________weekly Submitting ______ carcase swabs (pooled/not pooled) and _____ surface swabs Please provide appropriate sampling and packing materials including pre-paid postage. |
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| Any additional requirements... | ||
| Please provide a quote for carrier pickup
for next day delivery Tick here |_| ------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------- |
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Please Fax to 01845 577778
Note: This information is requested in order to ensure that the necessary computer records are created, ideally in advance of sample reception. This is to help avoid mis-identification of data and ensure prompt reporting of the results to the correct person. Once you have been allocated a site code please use this on the sample submission form.