Sample Submission

List each sample by name and lot number, select which assays are needed for each, and add any relevant formulation details. Covers cytotoxicity, mutagenicity, eye irritation, and skin corrosion testing.

Available assays on this form

S-3001Acute Systemic Toxicity, OECD 129

S-4001Gene Mutation Test, HPRT (OECD 476)

S-5001Cytotoxicity & Viability, MTT / Neutral Red

S-1001Eye Irritation Test (IVD EIT™)

S-2001DermaSafe Skin Corrosion Test™ (DermaSafe SCT™)

Use this form to request testing services for your samples. Fill in your contact details, list each sample by name and lot number, select the assays needed, and choose a payment method. Once submitted, you will receive a reference number and a printable Service Request Form to include with your shipment.

Your Contact Information

First Name *

Last Name *

Email *

Phone

Company *

Job Title

Report Delivery Email(if different from contact email)

Your completed study report will be emailed to this address. IVD EIT reports may include large image files, in those cases you will receive a secure download link with login credentials.

Samples & Assays Requested

Enter each sample's name, lot number, and concentration or formulation. Check which assays are required - each sample can have a different combination.

Sample Name *

Lot # *

Conc. / Form.

Acute Toxicity

HPRT Mutation

Human Cell Cytotox

IVD EIT™

DermaSafe SCT™

Cell types for Sample 1, MTT Viability

Sources: Lonza · ATCC. Estimates only.

No cell types selected, select above, or leave blank and specify in notes.

Project Goals & Parameters

Describe the scientific objectives, regulatory context, concentration ranges of interest, or any specific parameters that should guide the study design.

Additional Notes

Shipping Instructions

Ship Samples To

Lebrun Labs LLC
3301 E. Miraloma Ave., Suite 194
Anaheim, CA 92806

* Attention: Test Services

1.Prepare 2 g or 2 mL of material per test requested. Label each container with sample name and lot number.

2.Print this form and include it inside your shipment package so our team can match samples to your submission.

3.Hazardous materials must be packaged per DOT/IATA regulations with SDS documentation enclosed.

4.After shipping, email your tracking number and service request reference number to info@lebrunlabs.com. Your reference number will be shown on the confirmation page after you submit.

To receive a copy of this form by email, enter your address in the submission area below.

Payment Method

Terms and Conditions of Sale

I have read and agree to the . I understand that submission of samples constitutes acceptance of these terms.

You must agree to the Terms and Conditions of Sale before submitting.

Submitting opens your email client with a pre-filled message to sales@lebrunlabs.com. If you prefer to use a different email address, enter it below.

Get a Copy of This Service Request Form

Enter one or more email addresses below and a formatted copy of this completed form will be sent automatically when you submit. Separate multiple addresses with a comma.

Please check your spam or junk folder if you don't see the copy within a few minutes. Add info@lebrunlabs.com to your contacts to ensure delivery.

Before you submit

!First & last name

!Email address

!Company name

✓At least one assay selected

!Terms & conditions accepted

Lebrun Labs LLC · 3301 E. Miraloma Ave., Suite 194, Anaheim, CA 92806 · (714) 345-4689

Sample Submission | Lebrun Labs

Sample Submission