Please fill out this form and click on the SUBMIT button at the bottom (* Indicates a required field). The submit form will be E-mailed to us and a confirmation page will appear on your screen. Please print a copy of the confirmation page for your records. Please also include a copy of the confirmation page in the box with your sample.
HINT: Use the tab key to move in between fields.
If you prefer to have a Sample Submit Form e-mailed to you (in Word or WordPerfect format) so it can be filled out and e-mailed back to us, please send your request via E-mail.
Ship samples to ALTECA Ltd., 731 McCall Road, Manhattan, KS 66502
Tel: (785) 537-9773, Fax: (785) 537-1800, Click here to send us an E-mail
I understand that by clicking on the Submit Form button below, I am ultimately responsible for the charges incurred during the testing, consulting, and/or examination of the above referenced sample.
PLEASE CLICK THE 'Submit Form' BUTTON BELOW.DO NOT JUST PRINT THIS PAGE FROM YOUR BROWSER. AFTER YOU SUBMIT THE FORM, YOU WILL RECEIVE A CONFIRMATION PAGE THAT YOU CAN PRINT FOR YOUR RECORDS.PLEASE ALSO INCLUDE A COPY OF THE CONFIRMATION PAGE WITH YOUR SAMPLE WHEN YOU SHIP IT TO THE LAB.