Request for Analysis Step 1 of 3 33% Client Information(*) = Required fieldsPerson Responsible For Order*Personnel authorized to order testing must be on file at Green Leaf LabCompany*Email* PhonePhone 2AddressPlease indicate your facility locationStreetOregon CountyBakerBentonClackamasClatsopColumbiaCoosCrookCurryDeschutesDouglasGilliamGrantHarneyHood RiverJacksonJeffersonJosephineKlamathLakeLaneLincolnLinnMalheurMarionMorrowMultnomahPolkShermanTillamookUmatillaUnionWallowaWascoWashingtonWheelerYamhillCityZipCannabis MarketCannabis ProducerIndustrial Hemp ProducerCannabis ProcessorIndustrial Hemp ProcessorAdult UseWholesalerRetailerLaboratoryAll products in this sampling request must be destined for one market. “Adult Use” type is for non-licensed individuals.Sampling Location*Client FacilityGreen Leaf LabLicense NumberLicense Number Expiration Date Format: MM slash DD slash YYYY Batch Information(*) = Required fields. You will not be able to proceed to the next page unless all required fields are completed. Batch InformationBatch/Process Lot InformationMatrixUsable MarijuanaExtract or ConcentratesEdibleTopicalIndustrial HempCombined ProductOtherType of marijuana productType of TestingComplianceResearch and DevelopmentIs testing to comply with state requirements for consumer products, or for your own quality, study, and informationSample NameProduct or Strain NameHarvest/Process Lot IdentifierHemp harvest lot ID or Recreational/Medical harvest/process lot name and date.Source Package RFIDRecreational: Use METRC RFID tag for source package Batch Size IngramspoundsmillilitersunitsTotal Batch SizeAnalyses RequestedFor more information on the analysis product types, Click HereAnalysis Products Extract/Concentrate Full Compliance Useable Flower Full Compliance Moisture Content Mold Pesticide Potency Residual Solvent Terpenes Water Activity Retest of Previous Fail?NoYesIs this a retest of a batch that failed state compliance testing?Previous LabLab name or license number that failed the samplePrevious Failed DateControl Study InfoWill testing be applied under an existing control study?YesNoWill testing be applied to establish a new control study?YesNoIf yes, please complete the OLCC Control Study Certification Form prior to sampling appointmentAdd Another BatchRemove Batch GREEN LEAF LAB, LLC – TERMS AND CONDITIONSUpdated Jan 30, 2019I agree to the Terms and Conditions* YesIMPORTANT TERMS AND CONDITIONS OF SERVICE PRICING AND CHARGES: Prices to be charged for work performed are due at time order is placed. Cancellation of testing services when GREEN LEAF LAB (Hereafter, GLL) employee is in transit or on-site will incur an automatic fee of $250. Cancellation of order after sampling has begun or while sample in transit will result in a cancellation fee of 50% of order or $500, whichever is greater. No refunds provided for cancellation of order after samples have been delivered to laboratory. Reports may be withheld from release unless payment is current. Any checks from CLIENT, returned for insufficient funds, may be assessed a banking fee. REPORT/CERTIFICATE CHANGE REQUEST: A fee of $100 will be assessed for all changes to any published certificates of analysis. It is CLIENT'S responsibility to ensure all information provided to GLL on all required documentation is correct. DELIVERY & LIABILITY LIMITATIONS: GLL will analyze samples requested and provided by CLIENT in accordance with the procedures documented in the GLL Quality Manual (QM). GLL assumes no responsibility for the accuracy of any information related to the samples (whether GLL or CLIENT information) and shall not be liable if reliance on such information results in incorrect conclusions or results. CLIENT SHALL FURTHER INDEMNIFY AND HOLD HARMLESS GLL FROM AND AGAINST ALL LIABILITIES, LOSSES, COSTS, DAMAGES, CLAIMS (INCLUDING THIRD PARTY CLAIMS), OBLIGATIONS, FEES AND EXPENSES, ARISING OUT OF: (I) RELIANCE ON ANY INFORMATION THAT RESULTS IN INCORRECT CONCLUSIONS OR RESULTS; (II) BUSINESS LOSS, PERSONAL INJURY OR DEATH ALLEGEDLY CAUSED BY PROVISION OF SERVICES OR USE OF CLIENT’S PRODUCT BY ANY INDIVIDUAL. GLL may sub-contract out CLIENT sample. GLL does not guarantee turn-around times or timeliness of results. CONFIDENTIALITY: GLL will use its best efforts to treat all information regarding work performed for CLIENT as proprietary and confidential. CLIENT information will be released only to persons listed on the CLIENT INFORMATION FORM. GLL may be required to notify authorities of failed test results or other CLIENT information as required by law, regulation or code. It is the CLIENT'S responsibility to notify GLL in writing of any changes to persons listed on CLIENT INFORMATION FORM. LIMITATION OF LIABILITY & WARRANTY: GLL GIVES NO WARRANTY, EXPRESS OR IMPLIED, OR OF FITNESS FOR A PARTICULAR PURPOSE, IN CONNECTION WITH ITS ANALYTICAL TESTING, SAMPLING, OR REPORTING. ANY LIABILITY OF GLL TO CLIENT OR ANY THIRD PARTY SHALL BE LIMITED TO THE COST OF ANALYSIS CHARGED TO CLIENT. IN NO EVENT SHALL GLL BE LIABLE TO CLIENT OR ANY THIRD PARTY FOR ANY EXEMPLARY, PUNITIVE, INDIRECT, INCIDENTAL, SPECIAL, OR CONSEQUENTIAL (INCLUDING BUT NOT LIMITED TO LOST EXPENSES OR PROFITS) DAMAGES ARISING FROM OR IN ANY WAY CONNECTED WITH ITS PERFORMANCE OR FAILURE TO PERFORM, EVEN IF THERE IS EVIDENCE OF KNOWLEDGE OF THE POSSIBILITY OF SUCH DAMAGES. GLL DOES NOT GUARANTEE TURN-AROUND TIMES OR TIMELINESS OF RESULTS. NET 30 ACCOUNTS: Upon approval of CLIENT NET 30 application payment terms are NET 30 from the date of invoice. The following terms apply: CLIENT agrees to pay 3% FINANCING FEE if payment is not received within 45 days from invoice date. FINANCING FEE of 3% of monthly invoice assessed, until paid in full. CLIENT agrees to pay all GLL COLLECTION COSTS, including reasonable attorney fees and associated costs due to late or non-payment. Notwithstanding the foregoing, GLL reserves the right to refuse service for any reason. LITIGATION, APPLICABLE LAW & VENUE: Legal issues arising from work performed by GLL for CLIENT will be construed and interpreted in accordance with the laws of the State of Oregon; Venue of Multnomah County, Oregon. All costs associated with litigation, disputes, or any other purpose, will be paid by the CLIENT, including reasonable attorney fees and associated costs incurred by GLL. By ordering GLL services, CLIENT consents to all of the above Terms and Conditions. Terms and conditions are subject to change at any time without notice. Any order placed after the Terms and Conditions have changed will be subject to the new Terms and Conditions. Electronic Signature*Re-enter your name. Signature will also be required at time of sampling.Additional NotesAnything else we need to know?Submit Request You may review previous pages to ensure your request is correct. Pressing submit will send your request to Green Leaf Lab. A sampling representative will contact you to schedule your appointment.CommentsThis field is for validation purposes and should be left unchanged.