Home Paternity Testing Kit Order Form - Express DNA Testing

Home Paternity Kit Order Form

Step 1 of 4

25%

Participants*
Shipping Address*
Shipping*
Two Address Shipping*
A $5 handling fee is added for standard shipping to two addresses.
Total
$0.00

Participant #1
Name*
First Last
Date of Birth*
Relationship*
Participant #2
Name*
First Last
Date of Birth*
Relationship*
Participant #3
Name*
First Last
Date of Birth*
Relationship*
Participant #4
Name*
First Last
Date of Birth*
Relationship*
Shipping Information
Shipping Name*
First Last
Shipping Address*
Street Address City State ZIP
Shipping Name #2*
First Last
Shipping Address #2*
Street Address City State ZIP Code

Security Word/Number*
This security phrase will be used to verify your identity later when receiving results. Any word or phrase less than 8 characters is allowed.
Extra Information
Add any extra relevant information related to your home paternity test.
Contact Phone*
Contact Email*
Enter Email Confirm Email
Total
$0.00
Coupon

Billing Name
First Last
Billing Address*
Street Address City State ZIP Code

Please note that the card billing address must match the address on record with the credit card company where your statements are sent.
Credit Card*

American Express
Discover
MasterCard
Visa
Card Number Expiration Date Security Code Cardholder Name
Phone*
Email*

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