Click here: Chain of Custody Form to download the Chain of Custody form, click the link below. A copy of the file will be saved to your computer in Microsoft Excel format.
Instructions for Chain of Custody Form
- If you have too many samples for one form, please submit a separate form. Do not attempt to copy worksheets within this workbook.
- Fields in orange are required.
- Email your completed form to email@example.com.
|STANDARD REPORT or CERTIFICATE OF ANALYSIS||Indicate one or the other for the type of report you need in each row, by entering an X in the appropriate cell.|
|SPECIAL INSTRUCTIONS||Enter any Special Instructions for your sample(s) on the corresponding row. Examples include:
|RATE||This field pre-populates the Analyte Rate based on the Analyte you select on each row.|
|SUBTOTAL||This field pre-populates based on the total price of all Analytes selected.|
|PRE-PAY DISCOUNT||This field pre-populates based on the total price of all Analytes selected. To receive the following price breaks, you must have a zero account balance and call in a credit card order or check number that will be delivered with your samples. It does not apply to RUSH charges.
|TOTAL DUE||This field pre-populates based on the Subtotal minus any applicable Pre-pay Discount for Analytes selected.|
|PURCHASE ORDER #||Enter your Purchase Order number, if applicable.|
|AUTHORIZED BY||Enter the Name of the person authorizing the submission of this form.|
|COMPANY||Enter the name of the Company authorizing the submission of this form.|
|ADDRESS||Enter the company’s Address authorizing the submission of this form.|
|Enter the Email of the person authorizing the submission of this form.|
|SEND TEST RESULTS TO (IF DIFFERENT)||
|TELEPHONE||Enter the Telephone number of the person authorizing the submission of this form.|
|DELIVERED VIA||Select the means of getting the sample to the lab from the drop-down list.|
|PRE-PAY OPTIONS||Select the Pre-pay Option from the drop-down list.|
|DATE||Enter the Date you are submitting the form in the following format: dd/mm/yr|
If you need assistance downloading, completing, or sending a file, or would like to make suggestions for improving a document, contact Rebecca Hardy at firstname.lastname@example.org or (978) 417-2525 (cell), 9 am to 5 pm, Eastern Time.