Lakeland Health Care

Email Forms Manager

**Note:  Federal regulations enable us to supply only those materials necessary to submint specimens to our facility for testing.**

* Indicates required information
Lakeland Laboratory Printer Cartridges Supply Order Form 
Date *   Calendar (mm/dd/yyyy)
Client Name * 
Client Address 
Printer Cartridges 
Kit 6000 - 69G8256 
HP 1200 -C7115X 
HP 1300 - Q2613X 
HP 2015 -Q7553X 
Authentication * 

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