Important: Please read entire instruction sheet before beginning. Only collect one person’s sample at a time.
Note: In order to collect a proper sample it is important that person has a clean mouth. Adults and children: Rinse mouth three times with warm water. Infants: Allow infant to drink room temperature water from a bottle before sampling. Alternatively, if the infant is not drinking water, wait at least three hours from feeding. Do not smoke/chew tobacco or use mouthwash or toothpaste 2 hours before sampling. Samples must be received by GTL no more than 5 days from sampling.
Gather the following items prior to sampling. Do not touch swab tips with your fingers.
Note: You do not have to use the test participants’ real names for this type of test.
Small envelopes for individual samples are recommended, with a larger envelope for the complete kit package including sample envelopes, completed forms and payment.
When samples are complete, you will place the small envelopes into a larger envelope for mailing.
You are now ready to begin the actual sample collection.
| Paternity, Father and Child (Mother optional, + $15) | $95 |
| Maternity, Mother and Child (Father optional, + $15) | $95 |
| Siblingship, 2 Siblings (Include known parent, add $80 - recommended) | $150 |
| Missing Parent, Grandparents and Grandchild (Include known parent, no charge) | $260 |
| Twin Zygosity Fraternal or Identical, 2-siblings (Add one or both parents, add $80/per parent) | $150 |
| Grandparent, aunt or uncle 2-person test(Include known parent, add $80 - recommended) | $150 |
| Additional Family Members | $80 |
TO SEND SAMPLES BY US MAIL
Genetic Testing Laboratory
Genesis Center - A
MSC3ARP, Box 30001
3655 Research Drive
Las Cruces, NM 88003 USA
TO SEND SAMPLES BY FEDEX OR OTHER EXPRESS COURIER
DO NOT USE FOR US MAIL!
Recipient: John Arroyos
Company: GTL Genesis Center A
Address: 3655 Research Drive
City: Las Cruces
State: NM Zip: 88003
Phone: (575) 646-3465
I submit these samples willingly and understand that the expert will perform this test in accordance with the AABB Parentage Testing Standard in a confidential and professional manner. I acknowledge that the legal guardian or conservator consents to the parentage testing described within this document. I agree that once the sample has been taken that it becomes the property of GTL and I will no longer have access to the said sample unless otherwise dictated by a court of law.
The individuals involved in this testing ([ ]have not) ([ ]have) undergone a blood transfusion or stem/bone marrow cell transplant in the last three months. If so,
Explain: _______________________________________________________________
Date of Swab Sampling: ________/________/________ (mm/dd/yy)
_______________________________
Printed Name
_______________________________
Signature*
________/________/________
Signed On (mm/dd/yy)
Address________________________
_______________________________
_______________________________
Home Phone: ___________________
Work Phone: ___________________
Other Phone: __________________
*Your signature constitutes agreement to General Terms and Conditions that may be viewed at http://www.gtldna.com/TermsConditions.pdf.
If you want the actual names of the participants on your report, an unrelated third party who has no interest in the test outcome must witness collection.
_______________________________
Printed Name
_______________________________
Signature
________/________/________
Signed on (mm/dd/yy)
_______________________________
Street Address
_______________________________
City State Zip Code
_______________________________
Phone Number
Your Comments: ____________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
[ ] Paternity Father/Child $95
[ ] Add Mother $15
[ ] Maternity Mother/Child $95
[ ] Add Father $15
[ ] Siblingship $150
[ ] Missing Parent (Include known parent, no charge) $260
[ ] Twin Zygosity $150
[ ] Grandparent, Aunt or Uncle $150
[ ] Additional Family Members $80/each
Please choose how you would like to receive your results. Failing to select a delivery option may result in your results not being released. NOTE: Although results will be ready within 5 working days, shipment of the report by FedEx or US mail is scheduled 2 or 3 days thereafter to allow for final report processing.
[ ] US Mail of report: Free
(For orders from outside the contiguous 48 United States, the charge is $30.)
Street Address or PO Box:
_______________________________
_______________________________
_______________________________
[ ] Email delivery of test report: $5 for each email address listed. 2 addresses = $10, 3 = $15
_______________________________
Email Address
_______________________________
Email Address
_______________________________
Email Address
[ ] Notification of results by telephone: $10 for each number listed. 2 numbers = $20, 3 = $30
(For orders from outside the contiguous 48 United States, the charge is $20 for each number listed.)
_______________________________
Contact Name
_______________________________
Telephone Number
_______________________________
Contact Name
_______________________________
Telephone Number
_______________________________
Contact Name
_______________________________
Telephone Number
[ ] Priority US Mail of report: $10
(For orders from outside the contiguous 48 United States, the charge is $40.)
Street Address or PO Box:
_______________________________
_______________________________
_______________________________
[ ] Overnight FedEx* of report: $15
(For orders from outside the contiguous 48 United States, the charge is $50.)
*Street Address:
_______________________________
_______________________________
_______________________________
[ ] Rush: Notification of results by telephone and/or email within:
4 working days from sample receipt $50
3 working days from sample receipt $75
2 working days from sample receipt $125
1 working day from sample receipt $175
(For orders from outside the contiguous 48 United States, add $15 to the charges listed above.)
_______________________________
Email Address
_______________________________
Phone Number
*Note: Must be a street address. FedEx will NOT deliver to a PO Box. Telephone Number required for FedEx delivery.
Please total your amount below.
Example:
1 Paternity Test (includes Father and Child): $95
Add mother: $15
Add a second child: $80
Add Email delivery of test report: $5
Add Email delivery of test report to second Email address: $5
Add FedEx Delivery of report: $15
Total = $235
Your Order Total: $________
Please choose and complete one of the following payment options or call toll free (866) 833-6895 to pay by credit card over the telephone. By entering the requested information on this form, you are authorizing GTL to charge your bank account for the full amount of this transaction. This payment authorization is valid and to remain in effect unless you notify GTL of its cancellation by sending written notice prior to product shipment. Returned checks are subject to electronic redeposit without further notice. Recovery fees are assessed and may be debited from your checking account. By offering a check for payment, you agree to these terms.
<<<<<<<<<<<< !!! DO NOT SEND CASH !!! >>>>>>>>>>>>
[ ] Money Order. My money order is enclosed. Please make money order payable to GTL.
[ ] Personal Check (check must clear before samples are processed). My personal check is enclosed. Please make check payable to GTL. Remember to sign check.
[ ] Credit Card:
[ ] VISA [ ] MASTERCARD [ ] DISCOVER
Card Number: __/__/__/__/ __/__/__/__/ __/__/__/__/ __/__/__/__
Expiration Date: ____/____
[ ] AMERICAN EXPRESS
Card Number: __/__/__/__/ __/__/__/__/__/__/ __/__/ __/__/__
Expiration Date: ____/____
___________________________________________________________________
Name on Card, EXACTLY:
Address on Card Statement, EXACTLY:
Street ____________________________________________________________
City ____________________________ State _________ Zip _____________
Signature of Card Holder, (payment cannot be processed without a signature)
___________________________________________________________________
Authorized Signature