Eastern Analytical, Inc (EAI) - Container Request

* - Required Field

Reference Quotation

For a bottle order to be completed based on an existing quote, please submit the quote number and request containers.

Quotation Number

Enter a Quotation Number, submit request and your bottle order will be placed.

First Name

Tell us about yourself, what is your first name?

Last Name

Tell us about yourself, what is your last name?

Email Address

Please give us the best email address to contact you by.

ReOrder Bottle Order

For a bottle order to be duplicated based on a previous order, please submit the previous bottle order number and request containers

Order Number

Enter an Order Number if you want to duplicate that request.

First Name

Tell us about yourself, what is your first name?

Last Name

Tell us about yourself, what is your last name?

Email Address

Please give us the best email address to contact you by.

New Bottle Order Request

Please complete this form for new requests. It will be emailed to Customer Service at Eastern Analytical, Inc. Upon receipt, an acknowledgement will be emailed to you.

First Name

Tell us about yourself, what is your first name?

Last Name

Tell us about yourself, what is your last name?

Company/Organization

Who do you work for?

Email Address

Please give us the best email address to contact you by.

Where would you prefer the containers be delivered?
(if other than company address on file)

Attention

Who specifically should we send mail to?

Site

Which site do you want deliveries made to?

Street

Give us the street address to make deliveries to.

City

Give us the city name to make deliveries to.

State

Which State can we find the delivery site in?

Zip Code

Please give us the zip code of the delivery site

Phone

What is the best phone number we can reach you at?

Delivery Mode

EAI Courier

I Will Pick Up

EAI Decide

UPS

Which of these delivery methods works best for you?

Tell us about your project.

Project Name/ID

What is the name and/or number of your project?

Estimated Sample Collection Date

What is the estimated sample collection date?

Project Description

Please include sample quantities, matrices, analytical parameters and any project or regulatory requirements (i.e. regulatory program, reporting limits, methodology...) Note: Any QC Samples, MS, MSD, Duplicates and Blanks should be included in sample quantities.

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