SUPPLEMENT INTAKE FORM

COMPANY Information
COMPANY NAME
COMPANY ADDRESS

CITY
STATE
ZIP CODE

CONTACT NAME

CONTACT PHONE

CONTACT EMAIL

Billing Information
INVOICECREDIT CARDCHECK ENCLOSEDWIRE TRANSFER
BILLING ADDRESS

CITY
STATE
ZIP CODE

CONTACT EMAILsame as company information

MAKE CHECK PAYABLE TO:

KORVALABS, INC.
430 S. CATARACT AVE.
SAN DIMAS, CA 91773

  • BANK NAME: CHASE SOUTH PASADENA CA2-4237
  • ADDRESS: 1305 FAIR OAKS AVE,
    SOUTH PASADENA CA 91030
  • ACCOUNT HOLDER: KORVALABS, INC
  • ROUTING NUMBER: 322271627
  • FOR ACCOUNT NUMBER: Email us at INFO@KORVALABS.COM
  • SWIFT: CHASUS33

Product Information
PRODUCT NAME
MANUFACTURER NAME

LOT NUMBER
EXP. DATE
MFG. DATE

NO. OF CONTAINERS
AMOUNT PROVIDED
UNITS
Container: OpenedSealed

Test Requested

CUSTOM PANELS

SUPPLEMENT CERTIFICATION FOR SPORT (WADA PANEL)

SINGLE COMPOUND/RELATED COMPOUNDS

AMPHETAMINE (D/L)BOLDENONEBOLDIONECANNABINOIDSCLENBUTEROLCLOMIPHENECOCAINEDHCMT (ORAL TURINABOL)DHEADROSTANOLONE

GHRP-2GW-501516HEPTAMINOLHIGENAMINEHYDROCHLOROTHIAZIDEIBUTAMORENIPAMORELINLETROZOLELGD 4033MELDONIUM
METHAMPHETAMINE (D/L)METHYLHEXANAMINENANDROLONE (19-NOR)OPIOIDSOSTARINESTANOZOLOLTESTOSTERONE (AND RELATED)TRENBOLONETRIAMTERENE

OTHER COMPOUNDS

ship to
  • Step 1

    COMPLETE ONE FORM PER SAMPLE.

  • Step 2

    CAREFULLY SECURE ALL SAMPLES AND MAKE SURE THEY ARE ALL CLOSED PROPERLY TO AVOID LEAKAGE.

  • Step 3

    INCLUDE ONE COMPLETED FORM PER SAMPLE IN SHIPPING BOX.

  • Step 4

    SHIP WITH TRACKING VIA COMMON CARRIER TO:

    KORVALABS, INC.
    430 S. CATARACT AVE.
    SAN DIMAS, CA 91773

lab use
  • Container:
  • OPENED
  • SEALED

CONDITION OF SAMPLE AND/OR COMMENTS: