SYNERGENE DNA TESTING - FAST, RELIABLE & ACCURATE DNA TESTING

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Request Form for Twin Zygosity Sample Collection Kit Items marked with an asterisk * are required fields The information you provide will be treated with strict confidentiality

Title
First Name	*
Family Name	*
Address	*

City	*
State/Region	*
Postal Code	*
Country
E-mail	*
Telephone No.
Fax No.

Additional Persons to be Tested

		(For more than twins)

Charge per additional person €125**

Additional Questions or Comments



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If you complete this form Synergene will store and process your data in accordance with the requirements of its Data Protection Policy and in keeping with the Data Protection Act 2001 of Malta.

The following information is secure and is for Synergene Profiling Limited purposes only.

**All prices are subject to 18% VAT when applicable.

Synergene is the DNA company you can TRUST!