Skip to content
info@LORdiagnostics.com
2550 Flowood Dr, Ste 301 | Flowood, MS 39232
RE-ORDER SUPPLIES
"
*
" indicates required fields
If you have NOT yet created an account with us, please visit our online
Account Enrollment
Form. Current account holders may simply use the form below to submit a new order.
Account Information:
Facility/Clinic Name:
*
Address
*
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Attn:
*
Date:
*
MM slash DD slash YYYY
Kits
*
Quantity
KIt Type
5
10
20
30
50
75
100
Derm T.R.A.C. with Swab Kit
Derm T.R.A.C. with Tissue Kit
Fungal/Nail T.R.A.C. with Collection Bag Kit
Fungal/Nail T.R.A.C. with Collection Cup Kit
Fungal/Nail T.R.A.C. with Swab Kit
GI T.R.A.C. with Swab Kit
Ortho T.R.A.C. with Swab Kit
Ortho T.R.A.C. with Tissue Kit
Respiratory T.R.A.C. with Nasopharyngeal Swab Kit
STI T.R.A.C with Swab Kit
Surgical T.R.A.C. with Swab Kit
Surgical T.R.A.C. with Tissue Kit
Urine T.R.A.C. with Vacutainer
Vaginal T.R.A.C. with Swab Kit
Wound T.R.A.C. with Swab Kit
Wound T.R.A.C. with Tissue Kit
Add
Remove
Other address
Ship to another address
Address
*
Street Address
State / Province / Region
ZIP / Postal Code
Please make note of any additional items or special requests:
CAPTCHA
