Ameriwater Water Analysis Request

Submit your water analysis request and sample information for AmeriWater Lab Services. Please complete all required fields to avoid delays.

A reusable pre‑filled template can be created for future submissions. If selected, your confirmation email will include a 6-digit pre-fill code and direct pre-fill link. This code can be reused anytime you submit new samples.

Important: Templates can only be created from a valid lab sample submission. For example, if this is your first time submitting samples for a facility, select Yes to generate a template. Do not select this option when samples are not being sent in.

Create a template? Yes No

Requisition Submission Date Date Requestor Email Address example@example.com - This will be the point of contact that receives an email confirmation of submission

Billing Information

Billing Name

Billing Address Street Address

City State / Province

Postal / Zip Code

Billing Contact Name PO # Billing Contact Email example@example.com, name@company.com Billing Contact Phone Number Please enter a valid phone number.

Facility Information

Facility Name Account # Department

Facility Address Street Address

City State / Province

Postal / Zip Code

Lab Results Contact

Facility Contact Name Facility Contact Phone Number Facility Contact Email example@example.com, name@company.com

Replenishment Kit Sent Back? Yes No

Sample Date Date Sampler Name

AAMI Contaminant Section

Endotoxin Section

Endotoxin - Test? (00AAMI-LAL) Yes No

Microbiological Section

Microbiological - Test? (00AAMI-MICRO) Yes No

TOC Section

TOC - Test? (00AAMI-TOC) Yes No

Submission Information

To ensure we can trace any samples that do not arrive at the lab, please provide the mail carrier used for each shipment. This allows us to contact the carrier directly and investigate what may have happened in transit.

Shipping Carrier UPS FedEx USPS Other

Please provide the tracking code for your submission

File Upload for Tracking Number (optional) Browse Files Drag and drop files here Optional. Uploaded tracking documents/photos are stored with the admin submission package.

Terms and Conditions Submission of any sample to the laboratory for analysis or testing constitutes the customer’s agreement and acceptance of, without reservation or exclusion, the terms and conditions below: 1. Orders for laboratory services are not binding until accepted by the laboratory. Acceptance of an unopened package does not guarantee acceptance of the contents. 2. We reserve the right to refuse any package or sample that is improperly marked, leaking or has unusual characteristics, which may include but are not limited to: color, odor, turbidity and or viscosity. Prior acceptance of samples or orders from any person, organization, corporation, or other legal entity does not constitute or imply a contractual obligation on the part of the laboratory to accept current or future orders from said person, organization, corporation, or other legal entity. 3. The customer is responsible for proper collecting samples in appropriate containers, exercising due care to avoid contamination, properly labeling, and packaging samples and shipping the samples in a manner that complies with all applicable laws and regulations. Customer shall indemnify and hold the laboratory harmless for all claims and penalties that may arise from the packaging and/or shipment of the samples to the laboratory including, but not limited to, damaged caused or occasioned by leakage or release into the environment of any hazardous, infectious, noxious, or regulated substance. 4. Payment: The customer agrees to pay all fees and applicable taxes relating to the analysis and/or testing services and supplies ordered by the customer, according to our terms of net 30. 5. Services: The laboratory warrants that the analysis and testing are performed using methods and materials that comply with the provisions of, ANSI/AAMI/ISO 23500 for dialysis and ANSI/AAMI ST108 for sterile processing, and that the results accurately represent the quality of the water at the time and in the condition that the samples are received in the laboratory. No other warranty including suitability of a particular purpose or acceptance of regulatory authorities in any state or jurisdiction is implied or may be made, orally or in writing, by any officer, employee, or agent of the laboratory and/or its affiliates. 6. Customer acknowledges and agrees that AmeriWater is not customer’s advisor and is providing no advice in respect to the use of the data supplied with the analysis. AmeriWater shall have no liability arising out of the use of this data, and customer agrees to indemnify, defend, and hold AmeriWater harmless from and against any claims, demands, liabilities and damages arising out of the use of the data. AmeriWater makes no additional warranties in respect to the services. AmeriWater and its representatives and its subsidiaries and affiliates disclaim all implied warranties including without limitation warranties of merchantability and fitness for particular purpose relating thereto or this order. * REQUIRED