Lumegen - Avian Test Kits

Lumegen - Avian Test Kits - Order Form
Name & Surname:*
Contact Number:*

Area CodePhone Number
E-mail:*
Are you a member of PASA?*

YesNo
If yes, state PASA no:*
Quantity Kits ( 20 per package ):*
Please state how your samples must be send:*

CourierSA Registered Post
Courier Address ( Street ):

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Postal Address ( PO Box ):

PO Box

Address Line 2

CityState / Province

Postal / Zip CodeCountry
Cheapest courier (R50/R100) / Name your preferred courier ex. Postnet or Courier Guy
Courier Service:
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Lumegen - Avian Test Kits - Order Form