"  WE GIVE YOU ALL THE ANSWERS YOU NEED "

DNA CURIOSITY TEST   DNA LEGAL TEST    PRENATAL DNA TEST  

  GRAND PARENTAGE TEST   INFIDELITY TESTING   IMMIGRATION TESTING    

ESTATE  --  WILL -- TESTING   DNA STORAGE SERVICES

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DNA STORAGE BANKING  ORDER FORM

 

Please complete to the best of your ability.  

       Client Information      

First Name
Last Name
Address
City
State
Zip
Country
Contact Phone
Relation
E-Mail

 Individuals to be Tested

FAMILY MEMBER -- DNA STORAGE FOR 15 YEARS - NO OTHER SERVICES.  FOR STORAGE AND DNA PROFILE TEST PLEASE GO TO OPTION # 5 AND THEN CHOOSE NON - CHAIN OF CUSTODY OR CHAIN OF CUSTODY

First Name
Last Name
Date of Birth	Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec / 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 / 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 1935 1934 1933 1932 1931 1930 1929 1928 1927 1926 1925

 2. OPTIONAL --  FAMILY MEMBER

First Name
Last Name
Date of Birth	Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec / 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 / 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 1935 1934 1933 1932 1931 1930 1929 1928 1927 1926 1925

 3. OPTIONAL -- FAMILY MEMBER

First Name
Last Name
Date of Birth	Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec / 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 / 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 1935 1934 1933 1932 1931 1930 1929 1928 1927 1926 1925

 4. OPTIONAL -- FAMILY MEMBER

First Name
Last Name
Date of Birth	Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec / 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 / 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 1935 1934 1933 1932 1931 1930 1929 1928 1927 1926 1925

5. OPTIONAL -- 13 MARKER FBI CODIS PROBE LOCI DNA  PROFILE --  And 15 Year Storage Service.  CHAIN  OF CUSTODY OR  NON - CHAIN OF CUSTODY AVAILABLE 

PLEASE DESIGNATE WITH THE LETTER " Y"  BELOW. 

Non - chain of custody
Chain of custody

Report Information

Should we send a DNA report to the individual at the above address ?	Yes     No
Would you like a DNA report to be sent to anyone else ?	None Requester Child A Child B Father A Father B Mother

Payment Information

DNA Storage banking services includes storage of one individuals DNA sample for 15 years. The fee is $175 us dollars . The fee for DNA storage for up to 4 members of your family for a period of 15 years is $595 us dollars.  

The fee for DNA storage banking services for 15 years with chain of custody is $395 us dollars. These tests are admissible in a court of law and recommended in will and inheritance claims or simply to protect your estate against false claims when you are deceased. Each additional party is subject to $150 usd testing fee. 

DNA Profile ID services includes 15 years of DNA storage services including storing your DNA and extracting your DNA profile via PCR method using an FBI 13 marker CODIS probe loci. You will receive documentation showing numbers that represent the size of your DNA at certain locations on your chromosome. The fee for DNA profile ID and storage services is $510 us dollars.  Each additional party is subject to $150 usd testing fee. 

DNA Allele Sizing Services -- Chain of Custody --  includes storage of your DNA sample for 15 years and a court admissible documentation of your allele sizes. The fee is $595 us dollars.

We will contact you within 24 - 48 hours regarding the sample collection facility you must attend to submit your DNA samples for the chain of custody test. All chain of custody documentation will be included with your DNA sample collection kit. 

 

Please select the method of payment:

Credit Card   Money Order   Bank Draft   Check

Credit Card Information :

Cardholder's Name
Card Type	MasterCard Visa Pull down to select American Express Diner's Club/Carte Blanche
Card Number
Expiration Date	01 02 03 04 05 06 07 08 09 10 11 12 / 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
Amount

PLEASE NOTE THE FOLLOWING : 

A DEPOSIT IS REQUIRED TO INITIATE AND SCHEDULE YOUR TEST PROCEDURE DEPENDING ON YOUR CHOSEN TEST. THE REMAINING FUNDS MAY BE ENCLOSED WITH RETURN OF SAMPLES.  

   1. DNA STORAGE SERVICE 1 PERSON -- $75.00 

                2. DNA STORAGE SERVICES 4 FAMILY MEMBERS -- $200.00

   3. DNA PROFILE ID BANKING STORAGE -- $200.00

   4. CHAIN OF CUSTODY DNA BANKING-- $200.00 

   5. CHAIN OF CUSTODY DNA STORAGE   ALLELE SERVICE $200

Additional Comments