Testing Supplies Request Midlands Testing Services, Inc. Supply Request Form Please fill out the following form to submit a supply request to Midlands Testing Services, Inc. Do NOT wait until the last minute to order your supplies, as it can take over a week for you to receive them. If you have any questions please contact the call center at (402) 983-9590. Name* First NameLast Name Email* example@example.com Shipping Address* Street Address Street Address Line 2 City Please Select Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming State Zip Code INSTRUCTIONS Please select the items that you need to re-order below. Supplies are listed by company, if you need items from more than one company please select multiple. Alcohol Testing Forms DOT ATF’s Alton & SouthernAmtrakBelt Railway Company of ChicagoBNSFBoeingCaltrainCanadian NationalCapMetroConrailCSXCT RailG&W (GRSI)Herzog-ACEHerzog – BrightlineHerzog – SilverlineHerzog – TexRailHerzog – TREHerzog Contracting Corp.Herzog – TechnologiesHSR ConstructorsKansas City StreetcarLJA RailMetrolinkNew Jersey TransitNew Orleans Public Belt RailroadNorfolk SouthernOklahoma City StreetcarOmniTRAXP&L Evansville WesternP&L Midway SouthernP&L Appalachian & OhioPan Am RailwaysPatriot RailPort of Los AngelesRail RunnerSkyWest AirlinesSouthwest AirlinesSunRailTranstarTri-RailUnion Pacific NON-DOT ATF’s Alton & SouthernAmtrakBelt Railway Company of ChicagoBNSFBoeingCaltrainCanadian NationalCapMetroConrailCSXCT RailG&W (GRSI)Herzog-ACEHerzog – BrightlineHerzog – SilverlineHerzog – TexRailHerzog – TREHerzog Contracting Corp.Herzog – TechnologiesHSR ConstructorsKansas City StreetcarLJA RailMetrolinkNew Jersey TransitNew Orleans Public Belt RailroadNorfolk SouthernOklahoma City StreetcarOmniTRAXP&L Evansville WesternP&L Midway SouthernP&L Appalachian & OhioPan Am RailwaysPatriot RailPort of Los AngelesRail RunnerSkyWest AirlinesSouthwest AirlinesSunRailTranstarTri-RailUnion Pacific Urine Chain of Custody Forms DOT CCF’s Alton & SouthernAmtrakBelt Railway Company of ChicagoBNSFBoeingCaltrainCanadian NationalCapMetroConrailCSXCT RailG&W (GRSI)Herzog – ACEHerzog – BrightlineHerzog – SilverlineHerzog – TexRailHerzog – TREHerzog Contracting Corp.Herzog – TechnologiesHSR ConstructorsKansas City StreetcarLJA RailMetrolinkNew Jersey TransitNew Orleans Public Belt RailroadNorfolk SouthernOklahoma City StreetcarOmniTRAXP&L Evansville WesternP&L Midway SouthernP&L Appalachian & OhioPan Am RailwaysPatriot RailPort of Los AngelesRail RunnerSkyWest AirlinesSouthwest AirlinesSunRailTranstarTri-RailUnion Pacific NON-DOT CCF’s Alton & SouthernAmtrakBelt Railway Company of ChicagoBNSFBoeingCaltrainCanadian NationalCapMetroConrailCSXCT RailG&W (GRSI)Herzog – ACEHerzog – BrightlineHerzog – SilverlineHerzog – TexRailHerzog – TREHerzog Contracting Corp.Herzog – TechnologiesHSR ConstructorsKansas City StreetcarLJA RailMetrolinkNew Jersey TransitNew Orleans Public Belt RailroadNorfolk SouthernOklahoma City StreetcarOmniTRAXP&L Evansville WesternP&L Midway SouthernP&L Appalachian & OhioPan Am RailwaysPatriot RailPort of Los AngelesRail RunnerSkyWest AirlinesSouthwest AirlinesSunRailTranstarTri-RailUnion Pacific Instant Testing Forms Boeing Non-DOTGeneric Non-DOT Urine Collection Supplies Urine Cups YesNo CRL FormFox Labels YesNo Instant Testing Kits CaltrainCanadian NationalCapMetroHarbor RailKansas City StreetcarOklahoma City StreetcarTri-Rail BOEING QUEST RAPID RESULTS CUPS YesNo Oral Fluids Supplies Oral Fluids Canadian National Shipping Supplies CRL – Shipping Labels YesNo Quest – Shipping Labels YesNo Medtox Shipping Labels YesNo FedEx Shipping Bags YesNo Notes Quantity On Hand, Quantity Requests, Urgency, etc. Please verify that you are human* Submit Should be Empty:
