UIDL Client # * Facility Name * Contact Person * Contact Phone Number * Ship To: Street Address * Department or Room # * City * State * Zip * Date * Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year20222023202420252026 Please Select Any Component(s) You Wish to Order * Fed Ex Airbills Comprehensive Hematopathology Requisition Blood Collection Green Na Heparin 10 mL Tube Blood Collection Yellow ACD 8.5 mL Tube RPMI-1640 vials Biohazard Bag - 6”X9” Transport Box WITH Foam Tube Holder Formalin 10 ml Green Top NA Heparin Tube Lavender EDTA Tube Yellow ACD Tube Slide Transport Container with 5 Slides Fed Ex Shipping Bags Fed Ex Airbills - Specify Quantity Requested The UIDL provides Pre-Paid complimentary Fed Ex Overnight Service for our Flow Cytometry customers. First Order Only: Please provide your Fed Ex account number for the UIDL to use to place an order in the Fed Ex system. Your Airbills will be shipped directly to you by Fed Ex in approximately two weeks. Fed Ex Account Number Comprehensive Hematopathology Requisition - Specify Quantity Requested Blood Collection Green Na Heparin 10 mL Tube - Specify Quantity Requested Blood Collection Yellow ACD 8.5 mL Tube - Specify Quantity Requested RPMI-1640 vials - Specify Quantity Requested Biohazard Bag - 6”X9” - Specify Quantity Requested Transport Box WITH Foam Tube Holder - Specify Quantity Requested Fed Ex Shipping Bags - Specify Quantity Requested Formalin 10 ml - Specify Quantity Requested Green Top NA Heparin Tube - Specify Quantity Requested Lavender EDTA Tube - Specify Quantity Requested Yellow ACD Tube - Specify Quantity Requested Slide Transport Container with 5 Slides - Specify Quantity Requested Comment(s): CAPTCHAThis question is for testing whether or not you are a human visitor and to prevent automated spam submissions. What code is in the image? * Enter the characters shown in the image.