KFL: Sample Submission Form

Sample Submission Form
General Instructions. Please type or print. Check appropriate boxes. Use 2nd sheet for additional samples.	Return this form with samples to: KFL 21 Alpha Road, Suite D Chelmsford, MA 01824 USA	For more information: t 978-256-1220 f 978-256-1222 dkrueger@kfl.com

Company

Turnaround Required

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Standard

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Rush (priority charge applies)

Mailing Address

Send Results To The Attention Of:

Additional Assistance

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Fax Results (no charge)

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Email Results

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Send Brochure (Service and Fee Schedules)

Tel#

Ext

Fax#

Email Address

Date

Purchase Order #

SAMPLE ID & DESCRIPTION

Country of Origin

#01

#02

#03

#04

#05

#06

#07

#08

#09

#10

#11

#12

ANALYSIS REQUIRED

Expected Levels

___	Fruit Juice Authenticity
___	Flavor Analysis (indicate right)
___	Nutritional Analysis (indicate right)
___	Complete FDA/NLEA Nutritional Labeling Package (indicate serving size: ______________)
___	Proximates (ash, fat, moisture, protein, calories, carbohydrates)
___	Pesticide & Residue Analysis (indicate right)
___	Microbiology (indicate right)
___	Vanilla Analysis (indicate right)
___	Other (indicate right)

BACKGROUND INFORMATION / SPECIAL INSTRUCTIONS