This form is for submitting a test application to OptiGen ONLINE. Because the computer program will time out after a while, you should assemble all the information you will need in advance. If you are not sure what you need, go back (with your browser back button) and print a copy of the "Printable Form" to see the questions you will be asked.
You will be asked to print the following page, obtain signatures on it, and then include it with the sample package you send to OptiGen. Please read and print a copy of the Ship Sample instructions. If you do not want to submit your application online, please use our printable blank form which can be duplicated and completed by hand.