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BIO-SYNTHESIS, INC.
The DNA Identity Testing Laboratory of Bio-Synthesis, Inc. is Accredited by AABB.
612 E. Main Street, Lewisville, Texas 75057

Tel: (800)DNA-EXAM ; (888)786-9323  ;  (972)420-8505 (Outside US)

Fax: (972) 420-0442
Email: DNAtest@800dnaexam.com (Identity Testing Coordinator)

The DNA Identity Testing Laboratory is accredited by the American Association of Blood Banks.

APPLICATION FOR LEGAL DNA PATERNITY TESTING
Please complete this application and fax, e-mail or mail back to arrange a Legal DNA Paternity Test. Please print all information. A case consultant will notify the Contact Person to confirm receipt of the application and schedule DNA collection appointment(s) and/or request additional information.
I. Type of Test Requested (please check all that apply): 
    Paternity Test (Trio of alleged father, mother and child), $460.00    
    Paternity Test (Alleged father and child only), $460.00    
    Each additional child, $200.00
Number of additional people to be tested:		  
    Network DNA Collection Fee, $50.00/person:
Number of people to attend a Network DNA collection facility:		  
II. Parties To Be Tested: 
Alleged Fathers Name: Phone:
Date of Birth: Race:
Address:
City:
State: Zip:
Mothers Name: Phone:
Date of Birth: Race:
Address:
City:
State: Zip:
Childs Name: Phone:
Date of Birth: Race:
Address:
City:
State: Zip:
III. Appointment(s): 
Schedule parties:  
Together:
Separate:
Requested appointment(s) for:
Name:
Day:
M T W R F
Month:
Time:
AM  PM
(If next day appointment, must be after 3:00 PM)
Schedule parties:  
Together:
Separate:
Requested appointment(s) for:
Name:
Day:
M T W R F
Month:
Time:
AM  PM
(If next day appointment, must be after 3:00 PM)
IV. Method of Payment: 
If you choose to pay by money order or cashier’s check , make payable to Bio-Synthesis, Inc. Overseas money orders must be issued by the U.S. Postal Service. All funds must be payable in US dollars.
Please Check one:
Money Order Cashier’s Check American Express
Visa Mastercard Discover
If you choose to pay with Credit Card, please complete following:
Credit Card Number:   Expiration Date:  
Amount authorized: US$:   CVV Code:  
Name as it appears on the card:       (3 or 4 Digit on front/back of card)
Cardholder’s billing address:        
 
 
  I hereby give permission to Bio-Synthesis, Inc. to charge the above account for :
 
Deposit 50% of total amount
 
Full amount, once confirmed with Case consultant
     
     
(Signature of Cardholder)   (Date Signed)
 
Contact Person should be:
Attorney(s) Alleged Father Mother Adult Child
 
Attorney’s Name:
Address:
City:
State:
Zip:
Representing:
Phone:
Fax:
Attorney’s Name:
Address:
City:
State:
Zip:
Representing:
Phone:
Fax:
**FOR BIO-SYNTHESIS OFFICE USE ONLY**
 
 
Schedule Appointment:
Name(s):
Location:
Day:
M T W R F
Time:
AM  PM
 
Schedule Appointment:
Name(s):
Location:
Day:
M T W R F
Time:
AM  PM
 
Schedule Appointment:
Name(s):
Location:
Day:
M T W R F
Time:
AM  PM
 
Schedule Appointment:
Name(s):
Location:
Day:
M T W R F
Time:
AM  PM
 
 
Total Charge:        
Deposit Paid ( Minimum 50% of total amount): US$   Date:  
Balance Due: US$   Date:  
Paid in Full: US$   Date: