Please note: Our order forms for Clinical, Environmental, and Industry Microbiology are now combined into one form, and can all be ordered at the same time. A PDF version of this form is available here: PDF Order Form Order Form 2024 To receive shipments for a full year, please submit your order by March 22, 2024 Participant's InformationLab number* Laboratory Name* Date* MM slash DD slash YYYY Name – Lab's Main Contact Person* First Last Lab contact Email* Lab's Contact Phone* Ship To:* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Bill To: Same as previous Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country HPTA License No.* (mandatory for shipments to Canadian facilities, effective January 1, 2016) International labs please add “International”. Exempt labs add “Excempt”Purchase Order #* Ordered by* First Last OrderIs this your first time ordering with CMPT?*A one time administrative fee applies YES NO One time administration fee Price: Type of facility* Clinical laboratory – public Clinical laboratory – private Point of Care Testing Doctor’s office Environmental laboratory – public Environmental laboratory – private Cannabis Testing laboratory Select program categories to order Clinical Microbiology Programs Environmental Microbiology Programs Industry Microbiology Programs Select Clinical Microbiology Programs to Order* Clinical Bacteriology Category A Clinical Bacteriology Category C1 Supplementary Gram Clostridioides difficile toxin Enteric Parasitology – Ova and parasites Fungal Smear Mycology Full AFB Stain Trichomonas vaginalis Shiga Toxin Screening Molecular Enteric Panel Gastrointestinal Panel (bacteria, virus, parasites) Covid-19 Verification Panel (15 samples set) Covid-19 Proficiency Testing Program (Full subscription PT testing) Respiratory Panel (Full subscription PT testing) Covid-19 AND Respiratory Panel (save $400) RSV only Influenza A and B only Screening and Molecular – Select to order Select All MRSA (Methicillin resistant Staphylococcus aureus) VRE (Vancomycin resistant Enterococcus) GB (group B Streptococcus) CRE (Carbapenem resistant Enterobacteria) GAS (group A Streptococcus) Select Environmental Microbiology Programs to Order Drinking Water Recreational Water Drinking Water for HPC Sediment Water Soil/Sludge Select Industry Microbiology Programs to Order Cannabis Microbiology Clinical MicrobiologyClinical Bacteriology Category A Price: Clinical Bacteriology Category C1 Price: Supplementary Gram Price: Clostridioides difficile toxin Price: Enteric Parasitology – Ova & parasites – microscopy Price: Enteric Parasitology – Molecular Price: Mycology Full Price: Fungal Smear Price: AFB Smear Price: Trichomonas vaginalis Price: Shiga Toxin Price: MRSA Price: VRE Price: CRE Price: GAS Price: GB Price: Enteric Panel Price: Gastrointestinal Panel Price: COVID-19 and Respiratory Panel (Influenza A, B, and RSV) Price: Respiratory Panel (Influenza A, B, and RSV) Price: RSV Only Price: Influenza A and B Only Price: COVID-19 15 Test Verification Panel Price: COVID-19 Proficiency Testing Program Price: Environmental MicrobiologyDrinking Water and Recreational Water – please indicate number of sets Quantity Price: $2,306.02 Quantity Drinking Water Only – please indicate number of sets Quantity Price: $1,792.67 Quantity –Drinking Water Extra Set – April Quantity Price: $408.90 Quantity –Drinking Water Extra Set – July Quantity Price: $408.90 Quantity –Drinking Water Extra Set – October Quantity Price: $408.90 Quantity Drinking Water for HPC – please indicate number of sets Quantity Price: $514.33 Quantity Recreational Water Only – please indicate number of sets Quantity Price: $634.72 Quantity –Recreational Water Extra Set – April Quantity Price: $306.05 Quantity –Recreational Water Extra Set – August Quantity Price: $306.05 Quantity Sediment Water Price: Soil/Sludge Price: Industry MicrobiologyCannabis Microbiology Price: ShipmentHiddenCB ShipmentsHiddenC. difficile ShipmentsHiddenEnteric Parasitology OP ShipmentsHiddenEnteric Parasitology M ShipmentsHiddenFungal Smear ShipmentsHiddenMycology Full ShipmentsHiddenAFB ShipmentsHiddenTrichomonas vaginalis ShipmentsHiddenTrichomonas vaginalis and AFB ShipmentsHiddenShiga Toxin ShipmentsHiddenScreening and Molecular ShipmentsHiddenEnteric Panel ShipmentsHiddenGIP ShipmentsHiddenResp ShipmentsHiddenCOVID Verification PanelHiddenDW ShipmentsHiddenHPC ShipmentsHiddenRW ShipmentsHiddenDW and RW ShipmentsHiddenSediment ShipmentsHiddenSoil ShipmentsHiddenCannabis ShipmentsTotal number of shipmentsSelect Province/Territory and Area if applicable*BC – Metro Vancouver $20BC – Not Metro Vancouver $35AB $35MB – Winnipeg $40MB – Not Winnipeg $65NB $50NL-St John $60NL not St John's, Labrador $220NS $50NWT, NU $220ON $40PEI $50QC $40SK $40YT $220International $TBDInternational Shipping CostHiddenAB shipping costHiddenBC Not Metro Vancouver shipping costHiddenBC Metro Vancouver shipping costHiddenWpg/ON/QC/SK shipping costHiddenNB/NS/PEI shipping costHiddenNL St John'sHiddenNL not St John's, LabradorHiddenMB not Wpg shipping costHiddenNWT/NU/YT provincial far north areas shipping costShipment cost C1Is your province BC? YES NO Shipping Total Price: $0.00 GST 5% Price: $0.00 PST 7% Price: $0.00 Total $0.00 All prices are in Canadian Dollars. Bank Fees may apply. If your laboratory is TAX exempted, this will be reflected in your invoice Some samples and/or components and/or services may be subcontracted.Are you paying by Credit Card? YES NO
