Vendor Lab Case #:

Contact Information (to be completed by vendor lab):

Vendor Lab:	Date of last onsite visit program (OVP):
Name:	Phone #:
Title:	Email:
Date:

Case Information (to be completed by vendor lab):

Submitting Agency:
Agency Contact Name:
Phone Number:
Email:
Agency Case Number:

Case Background:
Full Description of Evidence:
Technology, Platform, Amp Kit & Software to be used:	STR kit: Y-STR kit: CE: GMID-X:

DPS will not incur any fees associated with the items submitted for testing from an outside agency. The entry of CODIS eligible profiles will be at DPS’s discretion. Vendor lab will provide the data in a DPS agreed-upon format.

Any expedited request agreement is between the vendor lab and the requesting law enforcement agency and is not applicable to DPS. Please contact DPS to make arrangements for expedited requests.

Approval (to be completed by DPS Technical Leader):

Name:	Phone #:
DPS location:	Email:
Signature:	Date: