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Form and Service Agreement • August 16th, 2020

ANALYSIS ORDER FORM AND SERVICE AGREEMENT Send samples by FedEx, UPS or DHL to:HRI Labs505 Dimick Dr. Room 111 Fairfield, IA 52556 E-mail order form to customerservice@hrilabs.orgor Fax order form to (641) 552-6257 or by U.S. Mail: HRI Labs P.O. Box 370, Fairfield, IA 52556 Questions? Please call HRI Labs at (641) 552-6258 Organization (Name to appear on Analysis Report) Organization:_ Address:_ Contact Person(s): E-mail Address: Phone: Fax: Test Results by E-mail, Mailor Fax: Please add additional contact fields, if necessary Person or Organization to Invoice (if blank, Organization information will be used) Organization:_ Purchase Order # Address:_ Contact Person(s): E-mail Address: Phone: Fax: Receive Invoice byE-mail, Mail or Fax: Please add additional contact fields, if necessary Sample Information No. Sample name Sample description Analysis Turn- aroundtime Sampling directions Test price Sample handling S

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