Enclosure (2) to COMDTINST 6510.1
DOD DNA SPECIMEN REPOSITORY
DNA COLLECTION SUPPLY ORDER/REORDER FORM
To order DNA collection supplies, complete all applicable blocks below. Sign the form at the
designated location and fax the form to the DoD DNA Specimen Repository at 301-295-4388, or
telephone at 301-295-4379. The form may be sent to the following address:
ARMED FORCES INSTITUTE OF PATHOLOGY
DOD DNA SPECIMEN REPOSITORY
ATTN COLLECTION SUPPLY REORDER
16050 INDUSTRIAL DRIVE, SUITE 100
GAITHERSBURG, MD 20877
INSTALLATION/SITE NAME________________________________________
Address of where supplies are to be delivered (NOTE: All CONUS addresses are shipped by UPS,
and must have either a building number, or street address for the supplies to be shipped to that
address. If there is no building number or street address the supplies will be shipped by USPS).
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
Point of Contact (Include rank if applicable)_________________
DSN Tel #____________________ Commercial Tel#_______________
Commercial Facsimile #_________________________
Number of Individuals to be collected__________
Do you need supplies in _____ kit or _____ bulk
Do you use the 6"x8" pouch _____ Yes _____ No
Do you use fingerstick devices to draw blood _____ Yes _____ No
Do you use mailing pouches furnished by Repository
to return specimens _____ Yes _____ No
Do you have Repository furnished heat sealers _____ Yes _____No
Signature and position of person
requesting supplies:___________________________________
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