DNA
  Bio Services

The Testing Kits is sent out FREE - However payment is required BEFORE the tests are sent to the Laboratory. Please tick the appropriate box(es) below for the Test you required and CALCULATE the cost and then email the completed form.
Please pay as soon as possible to avoid missing out on your results.
  Thankyou

DNA Test(s) Required:	tick a box
Peace of Mind Paternity Test
Father and Child 1	AU$ 395.00 (incl GST)
+ Additional Child 2	AU$ 148.00 (incl GST)
+ Additional Child 3	AU$ 148.00 (incl GST)
TOTAL Price AU$
NETSCAPE USERS NOTE: Please insert the TOTAL Price AU$ . . . manually the form calculator will generally NOT work in Netscape - sorry

Please enter your detail here:

the Field Names marked in RED: are REQUIRED a copy of the data in this form will also be forwarded to you for your records
Title:	Mrs. Ms. Miss Mr. Dr.
Name:
Postal Address:
Town/City:
State:
Postcode:
Phone:	ie: +61.8 9581 7575
Fax:	ie: +61.8 9581 7979
Mobile:
Email:	NOTE: Please supply a valid e-mail address - it is required ! a copy of this form will be sent to this address for your records
other Comments or Enquiry/Questions:

Payment can be made by filling in the following
  (including your Credit Card details) here :

PAYMENT OPTIONS:	Please select an option   CREDIT CARDCHEQUE via POSTDIRECT DEPOSIT
for Cheque & Direct Deposit options see instructions below .. for Credit Card option proceed here:
Credit Card Type :	select Card Type here VISAMASTERCARD
Credit Card Number :
Expiry Date :	Month : 010203040506070809101112   Year : 200720082009201020112012201320142015
Name on Card :
Security Number :	last 3 numbers back of card

you may now choose to . . . .
or   &  

If paying by Cheque, please print this page and send it with your cheque for the appropriate amount to DNA BioServices Pty Ltd PO BOX 1587, MANDURAH WA 6210 or If you are paying by Direct Deposit, our account details are: Commonwealth Bank DNA Bioservices Pty Ltd Acc Number: 10328599 - BSB: 066125 Please complete the form & click on [EMAIL this FORM] above + e-mail details of your Direct Deposit payment to contact details: phone: 1300 768 428 - fax: +61.8 6267 8085