Please note: MASI needs at least 10 days to prepare your order. If that is too long, call MASI at 614.873.4654, to see how we may accommodate your needs.

Client Information  

MASI Client # (CN)

Client Name 

Person Requesting Container / Bottle Order

Office / Plant Phone#   

Cell Phone #                

FAX#                         

Email address                                                                                          This email address will be used for your order confirmation.

Shipping / Delivery Information 

Please supply the shipping or delivery address below. 

Address 1    *

Address 2

City or Village 

State AL AK AZ AR CA CO CT DE DC FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN UT VT VA WA WV WI WY     Zipcode 

     *   Please Check if this address is different from the Client Address        

Do you wish MASI to ship it per UPS or deliver it by the MASI Route Driver? 

  Route Driver Ship UPS

If shipped by UPS, there is a Shipping & Handling Fee of:

$20.00 for Ground

   $70.00 for Overnight

If you want it delivered by a MASI Route Driver, please note when your next scheduled pick up is and the name of your driver (if you know) in the box below.

Needed Containers / Bottles

Please indicate what tests and how many you wish to run, and MASI will send you the correct number and types of  container(s) along with the neccessary  Analysis Request (AR) Sheet(s)

        POTABLE                   POTABLE              WASTEWATER             SLUDGE 

    Microbiological                Chemical                    Non-Potable

 (Example: TC 5)        (Example Nitrate 1)   (Example CBOD 2)    (Example: TCLP 2)

                                     (      or Hardness 3)    (    or FC 4 or SS 1)    (                or FC 2) 

  Please feel free to include any comments or notes in the following box.