Please use the following editable order form to initiate your order or click here to print your fax order form. If you have questions, would like assistance with ordering, or prefer to place your order over the phone, we are available Monday through Friday from 9 am to 5 pm Eastern time at 207-885-1072 ext1.

Contact Name:		Email:
Phone:		Fax:
Department:		PO Number:
Shipping Address
Company Name:
Attn:
Address:
City, State, Zip & Country:
	Shipping address is same as billing
Billing Address
Company Name:
Address:
City, State, Zip & Country
	For credit card purchases, please use the fax form or call MMQCI at 207-885-1072x1.

Product #	Product Name	Kit Configuration	Quantity
G104-1	INTROL™ TRC Genotype Control	3 bottles x 1 mL each
G104	INTROL™ TRC Genotype Control	3 bottles x 2 mL each
G105-1	INTROL™ MTHFR Genotype Control	3 bottles x 1 mL each
G105	INTROL™ MTHFR Genotype Control	3 bottles x 2 mL each
G106ac-1	INTROL™ CF Panel I Control	3 bottles x 1 mL each
G106ac	INTROL™ CF Panel I Control	3 bottles x 2 mL each
G106de-1	INTROL™ CF Panel I Control	4 bottles x 1 mL each
G106de	INTROL™ CF Panel I Control	4 bottles x 2 mL each
G110-1	INTROL™ CF Panel II Control	3 bottles x 1 mL each
G110	INTROL™ CF Panel II Control	3 bottles x 2 mL each
G115-1	INTROL™ CF Panel III Control	4 bottles x 1 mL each
G115	INTROL™ CF Panel III Control	4 bottles x 2 mL each
G11601	Xpert FII & FV NOR/MUT Control	4 bottles (2 Nor & 2 Mut) x 0.5mL
G108-2H	Xpert FII & FV HET	2 bottles x 0.5mL
G109	Xpert FII & FV Genotype Panel G109	4 bottles (2 HET, 1 NOR, 1 MUT) x 0.5mL
G123-1	INTROL™Thrombosis Genotype Panel	3 bottles x 1 mL each
G123-2	INTROL™Thrombosis Genotype Panel	3 bottles x 2 mL each
G200-1	INTROL™ HH Panel I	3 bottles x 1 mL each
G201-1	INTROL™ HH Panel II	3 bottles x 1 mL each
G20014-1	INTROL™ HH Wild Type	1 bottle x 1 mL each
M110	INTROL™ TB Panel M110	4 bottles x 3mL
P105-1	INTROL™ 2C19 Panel P105	3 bottles x 1mL
P110-1	INTROL™ 2C19 Panel P110	2 bottles x 1mL
P102-1	INTROL™ PGx 1 Control (warfarin)	3 bottles x 1 mL each
M210-T	FilmArray RP Panel M210 Trial Pack	6 tubes (3 each of M211 & M212) x 300uL
M210	FilmArray RP Panel M210	12 tubes (6 each of M211 & M212) x 300uL

Comments/Special Instructions:

After sending your order, a representative from MMQCI will contact you to confirm receipt and delivery date. Thank you for purchasing MMQCI quality controls. Sincerely, MMQCI Staff

Type verification image: