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<HTML>

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<META NAME="description" CONTENT="Benchmark Laboratories Group Ltd. provides analytical testing of organic and inorganic compounds in soil, water, air, industrial oil, animal manure and feed, as well as mold spore counting and identification">
<META NAME="Keywords"    CONTENT="analytical, laboratory, organic, inorganic, soil, water, air, mold, mold spore, manure, animal feed, testing, Calgary, Alberta, Benchmark">


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<TITLE>Request Form</TITLE></head>
<BODY  BGCOLOR="#FFFFFF"
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LEFTMARGIN="0" TOPMARGIN="0" RIGHTMARGIN="0" BOTTOMMARGIN="0"

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                                                        <TD colspan=2>&nbsp;</td>
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<input type="hidden" name="name_62" value="Name:">
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<font face='Arial' size='2' color='#333333'>

Name:

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<font color="red" size="-1">*</font></td>
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Company:

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<font face='Arial' size='2' color='#333333'>

Email Address:

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<font color="red" size="-1">*</font></td>
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<input type="hidden" name="name_71" value="Street Address">
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<font face='Arial' size='2' color='#333333'>

Street Address

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<font color="red" size="-1">*</font></td>
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<input type="hidden" name="name_72" value="City / Town:">
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<font face='Arial' size='2' color='#333333'>

City / Town:

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<font color="red" size="-1">*</font></td>
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Province / State:

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Postal Code / Zip Code

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<font color="red" size="-1">*</font></td>
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<input type="hidden" name="name_55" value="Please specify whether you require soil, water, air or other sample testing:">
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<font face='Arial' size='2' color='#333333'>

Please specify whether you require soil, water, air or other sample testing:

</font>


<font color="red" size="-1">*</font></td>
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<input type="hidden" name="name_56" value="Approximately how many samples do you require to be processed?">
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Approximately how many samples do you require to be processed?

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<font color="red" size="-1">*</font></td>
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                                                                <input type="text" name="field_56" size="35">
                                                                
                                                                
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<input type="hidden" name="name_57" value="When do you require an analysis report?">
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                                                        <TD VALIGN="top">


<font face='Arial' size='2' color='#333333'>

When do you require an analysis report?

</font>


</td>
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                                                                <select name="field_m_57" size="1">
                                                                <option>Jan
                                                                <option>Feb
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<input type="hidden" name="name_58" value="Do you have any questions for us?">
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                                                        <TD VALIGN="top">


<font face='Arial' size='2' color='#333333'>

Do you have any questions for us?

</font>


</td>
                                                        <TD>
                                                                
                                                                
                                                                <textarea name="field_58" rows="5" cols="30"></textarea>
                                                                
                                                                
                                                         </TD>
                                                </TR> 

<input type="hidden" name="name_59" value="How were you referred to us?">
                                                <TR>    
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<font face='Arial' size='2' color='#333333'>

How were you referred to us?

</font>


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<center><table border="0" cellpadding="0" cellspacing="3"><tr><td align="center">

<br><font face="helvetica,verdana, arial" size="1">&nbsp;</font>

</td></tr></table></center>
</TD></TR>
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<br>
<FONT FACE="verdana, arial, helvetica" SIZE="1">
<center>
<nobr>|<a href="index.html">About Us</A>|</nobr>

<nobr>|<a href="gpage.html1.html">Soil </A>|</nobr>

<nobr>|<a href="gpage1.html">Water</A>|</nobr>

<nobr>|<a href="gpage.html2.html">Air</A>|</nobr>

<nobr>|<a href="gpage.html7.html">Agriculture</A>|</nobr>

<nobr>|<a href="gpage3.html">Petroleum</A>|</nobr>

<nobr>|<a href="gpage.html10.html">Mold</A>|</nobr>

<nobr>|<a href="gpage.html5.html">Quality Assurance</A>|</nobr>

<nobr>|Request Form|</nobr>

<nobr>|<a href="gpage.html">Contact Us</A>|</nobr>

<nobr>|<a href="gpage.html8.html">Career Opportunities</A>|</nobr>

<nobr>|<a href="gpage.html11.html">Terms and Conditions</A>|</nobr>
</center>
</font>

<br><br>
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</table>
                
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<script language="javascript">
if (document.images)
var staticlogo=new Image()
staticlogo.src="images/Benchmark Labs LogoSM.jpg";
var logolink = "index.html"
var alttext=""
var fadeintoview=1;
var visibleduration=10;
</script>
<script language="javascript1.2" src="widgets/staticlogo3.js"></script>


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</body>
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