Order Form 2025 To receive shipments for a full year, please submit your order by March 21, 2025 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 Covid-19 Verification Panel (15 samples set) Trichomonas vaginalis Respiratory Panel (Full subscription PT testing) Shiga Toxin Influenza A, B, and RSV Screening Molecular Influenza A and B only Enteric Panel RSV only Gastrointestinal Panel (bacteria, virus, parasites) Covid-19 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: 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: Respiratory Panel (COVID-19, Influenza A, B, and RSV) Price: Influenza A, B, and RSV Price: RSV Only Price: Influenza A and B Only Price: COVID-19 Only Price: COVID-19 15 Test Verification Panel Price: Environmental MicrobiologyDrinking Water and Recreational Water – please indicate number of sets Quantity Price: $2,398.26 Quantity Drinking Water Only – please indicate number of sets Quantity Price: $1,864.39 Quantity –Drinking Water Extra Set – April Quantity Price: $425.26 Quantity –Drinking Water Extra Set – July Quantity Price: $425.26 Quantity –Drinking Water Extra Set – October Quantity Price: $425.26 Quantity Drinking Water for HPC – please indicate number of sets Quantity Price: $534.90 Quantity Recreational Water Only – please indicate number of sets Quantity Price: $660.11 Quantity –Recreational Water Extra Set – April Quantity Price: $318.29 Quantity –Recreational Water Extra Set – August Quantity Price: $318.29 Quantity Sediment Water Price: Soil/Sludge Price: Industry MicrobiologyCannabis Microbiology Price: ShipmentThis field is hidden when viewing the formCB ShipmentsThis field is hidden when viewing the formC. difficile ShipmentsThis field is hidden when viewing the formEnteric Parasitology OP ShipmentsThis field is hidden when viewing the formFungal Smear ShipmentsThis field is hidden when viewing the formMycology Full ShipmentsThis field is hidden when viewing the formAFB ShipmentsThis field is hidden when viewing the formTrichomonas vaginalis ShipmentsThis field is hidden when viewing the formShiga Toxin ShipmentsThis field is hidden when viewing the formScreening and Molecular ShipmentsThis field is hidden when viewing the formEnteric Panel ShipmentsThis field is hidden when viewing the formGIP ShipmentsThis field is hidden when viewing the formResp ShipmentsThis field is hidden when viewing the formCOVID Verification PanelThis field is hidden when viewing the formDW ShipmentsThis field is hidden when viewing the formRW ShipmentsThis field is hidden when viewing the formDW and RW ShipmentsThis field is hidden when viewing the formSediment ShipmentsThis field is hidden when viewing the formSoil ShipmentsThis field is hidden when viewing the formCannabis ShipmentsTotal number of shipmentsSelect Province/Territory and Area if applicable*BC – Metro VancouverBC – Not Metro VancouverNorthern/Remote BCABMB – WinnipegMB – Not WinnipegNBNL-St JohnNL not St John's, LabradorNSNWT, NUONNorthern/Remote ONPEIQCNorthern/Remote QCSK – Regina/SaskatoonSK – Not Regina/SaskatoonYTInternationalThis field is hidden when viewing the formShipment cost C1Is your province BC? YES NO Please note: We cannot provide a shipping cost for your order. Please contact us for details.Shipping total Price: $0.00 Credit card payments are subject to a 4% surcharge.Credit Card Surcharge Price: $0.00 Are you paying by Credit Card? YES NO How did you find out about CMPT?Returning Customer (Ordered Last Year)Word of MouthAdvertisementConferenceWeb SearchCMPT NewsletterSocial MediaOtherOther – Please Specify Total $0.00 All prices are in Canadian Dollars. Sales Tax is not included. Sales tax amounts will be available in the order confirmation and invoice. 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.
