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Supply Request Form Animal Health Diagnostic Center College of Vet Medicine, Cornell UniversityIn Partnership with the NYS Dept of Ag & Mkts Attn: Shipping, PO Box 5786, Ithaca, NY 14852-5786 Phone: 607-253-3935 Fax: 607-253-3551 E-mail: ahdcshipping@cornell.eduWeb: ahdc.vet.cornell.edu

PLEASE NOTE: SAMPLES SUBMITTED FOR TESTING BECOME THE PROPERTY OF THE ANIMAL HEALTH DIAGNOSTIC CENTER

AND MAY BE TESTED AS PART OF STATE/FEDERAL SURVEILLANCE PROGRAMS.

Prices are subject to change without notice.

Order Date: __________ Method: __ Employee: ______

Send to: AHDC Client Acct No.: __ _

Veterinarian’s Name:

Clinic Name: __ _

Address: ______

_______

City, State, Zip: ___

Email: _________

Phone: ________________ Ordered by (name):_________________

STYROFOAM TUBE MAILERS WITH MAILING SLEEVES: Price QTY Total (each)

800.100 1-TUBE CAPACITY 1.10 800.101 2-TUBES AND 1 SLIDE CAPACITY 1.30 800.102 3-TUBES CAPACITY 1.35 800.103 4-TUBES AND 4 SLIDE CAPACITY 2.25 800.104 5-TUBES CAPACITY 1.35 800.105 8-TUBES AND 4 SLIDE CAPACITY 2.50

OTHER MAILERS AND MAILING SUPPLIES: 800.200 BLOOD BOX, 40-PLACE, INNER BOX 2.00 800.201 BLOOD BOX, 40-PLACE, INNER BOX W/MAILER 4.00 800.202 SHIPPING POUCH (LARGE, 11”X11”) 95kPa 3.75 800.203 SHIPPING POUCH (SMALL, 7”X11”) 95kPa 1.00 800.208 THERMAL BUBBLE POUCH (For internal packing and insulation) 1.25 800.205 5-SLIDE CAPACITY PLASTIC MAILER .70

HISTOPATHOLOGY & BIOPSY SUPPLIES: 800.300 HISTOPATHOLOGY MAILER ONLY 1.25 800.301 4 OZ. CAPACITY JAR, WITH MAILER 95 kPa rated 1.75 800.302 4 OZ. CAPACITY JAR AND 10% FORMALIN, WITH MAILER 3.00 800.303 4 OZ. CAPACITY JAR AND 10% FORMALIN, WITHOUT MAILER 2.00 800.834 MINI BIOPSY CASSETTES .25

TUBES: 800.400 10 ML BLOOD COLLECTION TUBE, RED TOP .35 800.401 10 ML HEPARIN TUBE, GREEN TOP .75 800.402 7 ML EDTA TUBE, PURPLE TOP .25 800.403 7 ML TRACE ELEMENT TUBE, NAVY BLUE TOP 1.50 800.715 2 ML PLASTIC VIALS & CAPS .25

MEDIA: 800.500 AMIES BACTERIAL TRANSPORT MEDIUM, WITH CHARCOAL 2.25 800.501 AMIES BACTERIAL TRANSPORT MEDIUM, W/O CHARCOAL

(Universal media also recommended for Mycoplasma/Ureaplasma cultures) 1.50

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800.832 AMIES BACTERIAL TRANSPORT MEDIUM, WITH CHARCOAL MINI-TIP SWAB – ORANGE TOP

2.75

800.502 ANAEROBIC TRANSPORT MEDIUM WITH STERILE SWAB, Anaerobe 3.25 800.504 No. 1 EZ DRAW BLOOD CULTURE BOTTLE, 40 ML, AEROBIC

(Used for 0.1 – 5.0 mL blood volumes) 3.00

800.505 No. 2 EZ DRAW BLOOD CULTURE BOTTLE, 40 ML, ANAEROBIC (Used for 0.1 – 5.0 mL blood volumes)

3.00

800.835 VIRAL TRANSPORT KIT 4.70 800.508 TRICHOMONAS TRANSPORT MEDIUM – BOVINE 9.00 800.513 TRICHOMONAS TRANSPORT MEDIUM – FELINE 9.800.510 PARA-PAK FECAL TRANSPORT MEDIUM

(For Salmonella, Shigella, Campylobacter, Yersinia) 3.50

800.511 TUBES AND MEDIA FOR EAR NOTCH TESTING, WITH SHIPPING BOX (20 tube minimum order)

4.00

800.512 URINE TRANSPORT MEDIA .70

KITS: 800. ABORTION KIT, (Bovine=600, Small Ruminant=605, Camelid=606, or Equine=601) 34.00 800.602 DIARRHEA KIT, EQUINE, ADULT 20.00 800.603 DIARRHEA KIT, EQUINE, FOAL 35.00 800.607 EGG TEST KIT 40.00 800.609 FIELD NECROPSY KIT 50.00 800.615 SMALL THERMAL MAILER KIT 4.00

MISC. SUPPLIES: 800.700 3 OZ. CAPACITY STERILE URINE/FECAL SPECIMEN CUP, 95 kPa .25 800.706 ABSORBENT PAD, WHITE (each will hold 700 mL of liquid, or 10 mL per square in) .75

OTHER (Specify):

NO CHARGE SUPPLIES:

TEST & FEE SCHEDULE FOR THE AHDC NC GENERAL SUBMISSION FORM NC HISTOPATHOLOGY FORM NC ADDITIONAL COPIES OF THIS FORM NC U.S. POST OFFICE MAILING LABELS, ADDRESSED TO THE AHDC NC

PLEASE CONTACT THE LAB BEFORE ORDERING THE FOLLOWING ITEMS: 800.509 LACTATED RINGERS (For Vibrio and Trich) 1.75

FOR AHDC USE ONLY Total Order US Shipping Fee

CREDIT for return of: ________________ TOTAL CREDIT: ___________ $0 - $80 $10.00 800.800

$81 – $200 $15.00 800.801

Sub-Total Charges:

Order Shipped: ___________________________________________________ $201 – $400 $20.00 800.802

$401 + $50.00 800.803 Total Charges:Next Day delivery CHARGES ARE BILLED MONTHLY2nd Day delivery

+ 8.00+ .00

800.708 Box Return 800.713 Result Shipping 810.107 FedEx Next Day

800.711 Hard Cooler Return 800.815 Misc. Shipping charges 810.115 FedEx Sat. Label

800.709 Forward Sample 800.816 Misc. Supply charges 810.101 UPS Next Day

800.710 Return Sample 800.808 Add. Next day shipping 810.102 USP Ground

Ship/Handling Fee: