Mail In Order Form

Please fill out the order form below.

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Address Line 2

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Attn:

PO #

Kits

QTY	Kit	Analysis
	32oz Kit (contains 32 oz bottle, syringe, 1oz glass bottle and labels)	Standard screen, water & DGA, or Extendalife, Extendalife plus - needing D1816 dielectric
	16oz Kit (contains 16 oz bottle, syringe, 1oz glass bottle and labels)	Standard screen, water & DGA, or Extendalife, Extendalife plus - needing D877 dielectric

Individual Items

QTY	Item	Analysis
	16oz plastic bottles & label	Standard screen (D877), power factor, or corrosive sulfur
	32oz plastic bottles & label	Standard screen (D1816), power factor, or corrosive sulfur
	Syringes & label	DGA and/or moisture
	1oz glass bottles & label	Moisture or PCB or Furan

Comments or Special Instructions