Chem-Science Laboratories

ISO / IEC 17025 Accredited Independent Testing Laboratories

Established 1989

In association with ISO/IEC 17025 accredited Bio-Science Technologies (Pty) Ltd

Chemical Testing Laboratories, Biotechnologists and Microbiologists, Chemical Consultants

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Please complete online and submit to us, or print out and fax to us:

Agreement of Service Form

between: Chem-Science Laboratories cc

herein referred to as the Contract Laboratory and represented by: Director: V A Soffiantini, or his appointed alternative
and

Company Registered AND Trading names, in full:

herein referred to as the Client/Customer, and represented by:

Name of person representing the Client/Customer:
Company registration number:
VAT registration number:
Email address:
Telephone number including dialling codes:
Cellphone number:
Fax number including dialling codes:
Postal address including postal code:

Physical address including city code:
i.e.domicilium citandi or executandi (“domicillium”)

1. Whereas the Contract Laboratory has agreed to provide professional services to the client as follows:
Type of services requested by client:
e.g. Chemical laboratory tests.

2. This will be done subject to the following provisions:
Reports to be sent to:
e.g. your name or name of contact person.

Reports to be sent via one or more options below:
Phone Fax Post Certified Post E-Mail Collect Courier

3. Note the following conditions:

1. Reports will only be forwarded as instructed above, by the Client/Customer, provided that payments for the services rendered have been made, or alternatively prior written arrangement has been made with the Contract Laboratory’s management.
2. The contract services will be undertaken, in accordance with the above instructions, to the best ability and in good faith by the Contract Laboratory, subject to the Contract Laboratory’s Terms and Conditions of Business which shall apply to this Agreement.
3. This Agreement is valid for a period of (maximum 12 months) but may be subject to review, if requested by either party.
4. Any changes to these instructions made by either the Contract Laboratory or the Client/Customer must be recorded as an annexure (signed by both parties) to this Agreement; stating the change, the reason(s) for change and the effect the change will have on the professional services rendered.

4. Please indicate below how you found us so that we may improve our customer relations programme:
Regular Client   Yellow Pages   Website   Referral   Other     If "Other" please specify:

I/we acknowledge that I/we have read and accept the "Terms and Conditions of Business of Chem-Science Laboratories cc " and that the above information is correct: Client/Customer Signature Electronic signatures taken to be legally valid.
Signed at on this day of 2009.

NOTE: All information supplied to Chem-Science Laboratories is treated as strictly confidential.

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For Office use:

Received and signed on behalf of Chem-Science Laboratories cc: Contract Laboratory Manager's Signature

Date:

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