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Free Product Claim Form PDF Print E-mail

LSU Product Redemption Step 1: Contact Information

Lab Start-Up Product Redemption Form

 LSU Product Redemtion Form Banner

How to claim your FREE product:

Step 1: Enter how many product lines you would like to redeem (NOTE: please use a separate form for each supplier)
Step 2: Enter your contact information including your Lab Start-Up account number (6 digits, starts with "66")
Step 3: Enter the details of each FREE product you would like to redeem
Step 4: You will be asked to tick the box to show that you have read the Terms and Conditions

If you have a FISHERBRAND voucher to redeem please use this form »

All fields marked with a *(red asterix) are mandatory to complete the form.
Please enter your full company details. Do not enter your residential address as we only deliver to business addresses. Thank you.

Product Details

Number of product lines you would like to redeem:
NOTE: please use a separate form for each supplier
*

Customer Details

Title:
First name: *
Surname: *
Email: *
Job title:
Company name: *
Account number: *
Ship to:
Department:
Address street: *
Address:
Address (Area):
Address (post town): *
Postcode: *
Country:
Telephone:
Extension:
Fax:

Additional Information

House name / Building details:
School / Institute (e.g. Medical School):
Number of Scientists on site?:
How many people on your
site require safety equipment?:

Communication Mechanisms

Add me to mailing list? Prefer telephone
Prefer mail Prefer email
Prefer faxNo promotional contact

Verification

What is the day before saturday:
(enter in lowercase)
*
 

 

Last Updated on Friday, 19 April 2013 09:28