DNA Profiling and Banking Order Form

To order our DNA Profiling and Banking services, simply fill out the form below. Fields marked with an asterisk (*) are required. We accept online payments via MasterCard, Visa, and Discover. If you experience any difficulties ordering online, please call our representatives at 1-800-613-5768.

Personal Information

*Name
*Phone
*Email
*Mailing Address
*City
*State
*Zip

Payment Information

Type of Test Amount of Payment	Chain of Custody $145.00 - DNA Banking Only $280.00 - DNA Banking & DNA Profiling $280.00 - DNA Profiling Only Private Testing $50.00 - DNA Banking Only $195.00 - DNA Banking & DNA Profiling $195.00 - DNA Profiling Only
Card Type	Visa Mastercard Discover
Card Number
Expiration Date
Name on Card
Billing Address
City
State
Zip

Additional Comments/Instructions

One DDC Way Fairfield, OH 45014
1-800-613-5768

The Most Trusted Name in DNA Testing

DNA Profiling and Banking Order Form