CMPT Members Portal

Participant's Information
Laboratory Name*
Lab No.*
If you are a new lab, please enter 'NEW LAB'
Date
Ship To:*
Street Address Address line 2 City Province/Region/State Postal Code/ZIP Country
Bill To
Same as shipping

Street Address Address Line 2 City Province/Region/State Postal Code/ZIP Country
Lab Contact Name*
First Last
Phone*
Email*

Enter the email you would like to receive a copy of the order form and confirmation
Fax
Ordered by*
First Last
Phone
Email
HPTA (Human Pathogen and Toxin Act) License No.*
(mandatory for shipments to Canadian facilities, effective January 1, 2016) International labs please add "International"
Purchase Order No.

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Participant's Information