Quantrol UA Registration

Quantrol UA Registration Form

Effectively and efficiently manage laboratory time and resources with Quantrol UA^®.

Please select your preferred registration option:

Fax	Print and fill out this form then fax to: 310.536.0323 or 800.845.1834
Phone	Call Technical Support to request a form: 310.536.0006 or 800.624.8380
Email	Request a form via email: techsupport@4qc.com
Postal	Please print and fill out this form then mail to the address below: Quantimetrix Corporation Attn: Technical Support 2005 Manhattan Beach Boulevard Redondo Beach, CA 90278
Online	Fill out the form below.

Contact Person*
Facility Name*
Department
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone*
Fax
Email
Product 1
Product Name
Analytes Used (indicate units used if other than conventional)
Lot Number(s)
Level(s)
Reagent Test Strip Manufacturer
Reagent Test Strip
Instrument Make/Model
Instrument ID Name
Product 2
Product Name
Analytes Used (indicate units used if other than conventional)
Lot Number(s)
Level(s)
Reagent Test Strip Manufacturer
Reagent Test Strip
Instrument Make/Model
Instrument ID Name
Product 3
Product Name
Analytes Used (indicate units used if other than conventional)
Lot Number(s)
Level(s)
Reagent Test Strip Manufacturer
Reagent Test Strip
Instrument Make/Model
Instrument ID Name
By submitting your registration for Quantrol Online, you are also registering for online insert access and will be added to our Technical Update Notification program called TUN. The email address you submit will be added to the notification database. When a technical update is issued, you will receive an email informing you about which product is affected and that the update is available on our website. To access the technical updates and inserts on our website, you will use the login information we provide once your registration is complete.
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Print and fill out this form then fax to: 310.536.0323 or 800.845.1834

Call Technical Support to request a form: 310.536.0006 or 800.624.8380

Request a form via email: techsupport@4qc.com