In the United States, if you are a licensed physician you may order the NMP22® BladderChek® Test by simply filling out the form below. NMP22 BladderChek Test is FDA-approved for both monitoring and diagnosis of bladder cancer patients. A confirmation of your order will be sent to you upon completion of the order. If you have any questions regarding your order, please call our Customer Services Department at 800-320-2521 ext 1.

If you are interested in the NMP22® Test Kit, the test is in the process of being incorporated by laboratories at many of the nation's leading medical institutions. In addition, most of the major national reference laboratories, including Laboratory Corp. of America, SmithKline Beecham Clinical Laboratories and Quest Diagnostics now offer the test.

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	* NOTE: Phone # AND either FAX or email address required for     order confirmation and shipping
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Product Information
	Units*	Item#	Description	Unit Price	Total
		D1200	NMP22 BladderChek Test- Box of 24 Tests	$628.80	$
		D1250	NMP22 BladderChek Test- Control Kit	$58.00	$
				Subtotal	$
	Please Note: This order form is for United States doctors only. This form does not include sales tax. You will be contacted by a Matritech representative to determine your cost of shipping and sales tax. Returns Buyer may not return product. If, however, any Product fails to perform in accordance with the labeling provided by Matritech as documented by an examination of the Product pursuant to a formal complaint handling procedure established in accordance with standard industry practices, Buyer may return such defective Product upon obtaining an authorization from Technical Services. This authorization shall include an Authorization Number which must be affixed to any product returned. Shipping FOB Matritech Net 30 days For more information please contact us at: 800-320-2521 ext.1 or email: nmp22@matritech.com