Hair Drug and Alcohol Testing Registration // Cellmark

Thank you for chosing Cellmark. We have retrieved your quote information and updated the registration form below. Please complete the remaining fields before clicking the 'Register my case' button. If your testing requirements have now changed you can adjust the options on the form but please note a new price may apply.

Customer Contact Details

First Name *

Last Name *

Email *

Phone *

Organisation

Address Line 1 *

Address Line 2

Town/City

Postcode *

Your reference

Purchase Order Reference

Court Date (if known)

Testing Requirements

First Name *

Last Name *

Date of birth *

Sampling Contact

First Name *

Last Name *

Phone *

Email *

Address Line 1 *

Address Line 2

Town/City

Postcode *

Payment Information

Will you be responsible for the full payment? *

Yes
No

Please be aware that you may be liable for the full amount should we be unable to collect payment from any additional parties within 30 days from invoice date. We reserve the right to decline a request to perform testing under our usual credit terms, and to require payment in advance. In the event of cancellation, you may be liable for cancellation fees in line with our standard terms and conditions.

Additional Payment Party 1

Organisation

Contact Name *

Their Reference

PO Reference (if applicable)

Share of Invoice

Address *

Postcode *

Phone *

Email *

Additional Payment Party 2

Organisation

Contact Name *

Their Reference

PO Reference (if applicable)

Share of Invoice

Address *

Postcode *

Phone *

Email *

Additional Payment Party 3

Organisation

Contact Name *

Their Reference

PO Reference (if applicable)

Share of Invoice

Address *

Postcode *

Phone *

Email *

Please tick to confirm you are over 18 and have read and agree to our terms and conditions *

Case Registration