DNA TEST ONLINE ORDER FORM.
To Do List
|
|
Label a paper bag or paper
envelope (do not use a plastic bag) with the name of each person being tested.
For example (Bob-Father, Mr. X-Father, oldest Son, Shirley-Daughter, etc.)
|
|
|
Please read the terms and conditions below. You must sign
to show you understand and agree to them. If you have any questions, you
can email at dna@dnanow.com.. |
|
|
For instructions on taking a buccal swab, or by using cotton
buds or a toothbrush that you can supply yourself, visit and print the link
http://www.dnanow.com/usa/buccal_print.htm |
|
|
For instructions on taking Hair Samples, visit and print
the link http://www.dnanow.com/usa/hair_print.htm |
You can send this form by
|
Mail
|
Fax
|
Email
|
|
|
|
|
DNA SOLUTIONS
5312 Bayridge Road
Rancho Palos Verdes
CA 90275
|
1-866-2-DNA-696
|
dna@dnanow.com
|
|
|
|
Now, complete the following contact details
| Full Name: |
|
Phone Number:
|
|
| Address: |
|
| Email: |
|
Fax (optional):
|
|
Please tell us who is submitting samples:
|
Relationship
|
Identification
as written on your samples
|
Official Use
(don't fill)
|
| Father |
|
|
| Mother |
|
|
| Son |
|
|
| Son |
|
|
| Daughter |
|
|
| Daughter |
|
|
|
|
|
|
|
|
|
|
Choose your test
| |
19 Loci Premium Test |
99.99% accuracy |
- $189.00 |
| |
23 Loci Super Test |
99.999+% accuracy |
- $249.00 |
| |
Extra Child/Father |
per additional person |
- $95.00 |
* If another possible father, other than father being tested now, is
a brother or close relative of the father being tested, when we highly recommend
you select a 23 Loci Super Test.
Your results extra option
|
|
Tick here to recieve print out of the DNA band images
from analysis computer. (extra US$39.00) |
My secret password is _____________________
This password will allow you to receive results via telephone - please do
not forget your password.
Term and Conditions
1.
We DNA Solutions warrant that the result of the analysis of biological
samples provided to us by you ("the customer") is correct but
subject to a margin of error of 0.001%. No further representation, warranty
or undertaking is given or made in relation to the result of analysis.
2. The information contained in the result of analysis is prepared
solely for the use of the customer to whom it is given or sent by DNA
Solutions.
3. In the very unlikely event that the result of analysis is found
to be in error, we shall refund to you any monies you have paid us in
respect of the analysis. Alternatively, we shall perform a further analysis
for you at no charge to you.
4. Subject to paragraph 3 above, we shall not be liable for any
loss or damage suffered by you or any other person as a result of the
provision to you of a result of analysis.
5. We make no representation, express or implied, that the result
of analysis is fit for any particular purpose. If you intend to use the
result of analysis in any court proceeding you should obtain independant
legal advice with regard to your legal rights and with regard to the cost
and practicalities of so using the result of analysis.
6. You warrant that you are legally entitled to possession of the
samples you have provided to us. You agree to indemnify us against any
loss or damage that we may suffer as result of you providing us with samples
which have not been legally obtained. You should obtain independant legal
advice about your legal entitlement to take or obtain samples of biological
material from persons other than yourself. We make no representaion that
you are legally entitled to perform any particular act in order to obtain
biological samples for analysis.
7. We will test 19 regions (19 loci) of DNA for a 19 Loci Premium
paternity test, and we will test 23 regions (23 loci) for a 23 loci Super
paternity test. Should any loci fail to yield a result (as may happen
with old or poor samples), we will give a final test result if we obtain
a result on 16 or more loci for a 19 Loci Premium Test, and 19 or more
loci for a 23 Loci Super paternity test.
I hereby agree to the terms and conditions set out above and
confirm the information I have given is correct.
|
|
| Full Name: |
|
| Signed: |
_____________________________ |
| Date: |
|
Full Name: |
|
| Signed: |
_____________________________ |
| Date: |
|
|
|
Written results can only be
supplied to persons who agree and sign the terms and conditions (above).
How would you like to receive your results?
Your payment option
* Please make checks payable to DNA Solutions
Credit Card Details
| Card Number: |
|
| Cardholder's Full Name: |
|
| Expiry date: |
|
| Signed: |
_____________________________ |
|