Can we help you find something?
1. Tell us where you would like us to mail the gift card:
Your Name
Your Mailing Address
City
State
ZIP
Your email address

2. Your Account Number.   What is it? 

3. The new customer you referred:

Lab Name
Organization 
(University or Company)
PO# or Confirmation Number

 

Fill out the form within 10 days after the referred new customer places their first order and fax the form to Biologix at 913-648-6973.  The $15 gift card will be mailed to you within one week after the referral is verified. 


It is not valid if referred customer’s lab currently uses Biologix products.
 *VOID if prohibited by law & regulations

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