Submitted Sample Form Submitted Sample Form Applicant Name* Address* Street Address Address Line 2 City ZIP Code Phone* Certificate and Test Results Email* Sample Identification* Tests Protein Falling # Vomitoxin Aflatoxin Grade *Supplemental Vom *Supplemental Vom allows certification of actual results when results are over 5ppm, with max certification limit of 10ppm. This requires an additional test to be run and a fee of $35.00 will be billed separately. *Must be paid in full before inspection. Make payable to NPGIS. We do accept credit cards, credit card fees do apply to total. Please print an additional copy for your records/receipt. Total Price: $0.00 Other Information
