Abbott BinaxNOW Order Form

Abbott BinaxNOW Order Form

To be filled out by school district office or private school when testing supplies are low. BinaxNOW Testing Kits will arrive within approximately 7-10 business day to the address provided.

Date*

School Information

School District Name*

School Name if Not Shipping to School District Office

Shipping Address for Test*

Please note, test cannot be shipped to PO boxes.

City*

Zip Code*

County*

Please use the drop down menu to select the county that your school or school district resides in.

Select or enter value

Superintendent Information

This can also be filled out by the appointed delegee for this project.

Superintendent's Name*

Superintendent's Phone Number*

Superintendents Email Address*

Estimated Weekly Testing Volume*

Attestation Statement

I attest that I am ordering these tests on behalf of all schools in my district or for private school use. All schools performing testing have registered for the K-12 testing program.*

Send me a copy of my responses

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