Test Infidelity

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FORENSIC INFIDELITY
TEST FORM

For guaranteed confidentiality and anonymity, follow the "Confidentiality and Anonymity Instructions" contained in this document.

TERMS AND CONDITIONS

We (TEST INFIDELITY, hereinafter referred to as DTT CO) and/or its affiliates warrant that the result of the analysis of the biological samples provided to us by you (“the customer”) is correct and accurate according to the findings of the selected Laboratory, and based upon the origin of the samples provided to us. No further representation, warranty or understanding is given or made in relation to the results of analysis.

Fees paid to DTT CO are for testing only. In the event that genetic material is not found on the sample(s) provided to us (negative test result), all testing fees must still be paid. Your submission of a sample(s) to DTT CO is your authorization for DTT CO to render a testing result.

Sample(s) that are received without full payment will be held for ten (10) business days to allow for payment to be received by DTT CO. Sample(s) will then be destroyed. DTT CO is not responsible for storing sample(s).

The information contained in the result of analysis is prepared solely for the use of the customer to whom it is given or sent. Results can only be released verbally to individuals who have knowledge of YOUR SELECTED PASSWORD contained on this form (see below).

We cannot be held responsible in any manner whatsoever, for slow, or delayed results, or for circumstances not under our control. Additionally, we shall not be liable for any loss, or damage suffered by you, or any other person as a result of the provision to you, of the test results, or lack thereof.

In the event of it being necessary for DTT CO and/or its affiliates to testify in court or otherwise as to the identity of the persons sampled or the chain of custody procedure followed an additional charge will apply, and all charges must be paid in advance.

We make no representation, expressed or implied, that the result of analysis is fit for any particular purpose. If you intend to use the results of analysis in any court preceding you should email us at contact@testinfidelity.com so an appointment can be set up in your location for our legal collection services to guarantee that strict chain of custody procedures will be followed.

You warrant that you are legally entitled to possession of the samples you have provided to us. You agree to indemnify us against any loss or damage that we may suffer as result of you providing us with sample which have not been legally obtained. You should obtain independent legal advise about your legal entitlement to take or obtain in samples of biological material from persons other than yourself. I will make no representation that I am legally entitled to perform any particular act in order to obtain biological samples for analysis.

I hereby agree to the terms and conditions set our above and confirm the information I have given is true and correct.

SIGNED: __________________________________________

NAME (please print) __________________________________ Date: ____________________

PASSWORD ________________________________________

Sample Identification

Date of Collection: _______________

IMPORTANT: Information below should match information provided on Sample ID Slips.

Confidentiality and Anonymity Instructions: Use a false name or simply "Man 1" when completing the Sample ID slips and Forensic Infidelity Form. Make note of the false names you use.

Sample ID Slip #

Name

Type of Sample

________________________________

[ ] Forensic

[ ] Comparison

________________________________

[ ] Forensic

[ ] Comparison

________________________________

[ ] Forensic

[ ] Comparison

________________________________

[ ] Forensic

[ ] Comparison

________________________________

[ ] Forensic

[ ] Comparison

For Comparison Sample(s) (check one)

[ ] Test Comparison Sample(s) immediately and generate DNA profile (if possible)
or
[ ] Hold Comparison Sample(s) until testing on forensic sample(s) is complete

Please explain your testing needs below
(i.e., look for DNA on Sample 1 and comparison to DNA on Sample 2):

___________________________________________________________________

Please Note: Samples will not be returned upon completion of the test.

Notification of Results

Please indicate below how you would like to receive your results.

Confidentiality and Anonymity Instructions: Have your results emailed to a web-based email service such as Yahoo or Hotmail.

I would like to received my results via:

[ ] Email at _________________________

[ ] Mail at ________________________________________________________(see below)

By providing a mailing address, you are authorizing us to send material to your home and/or office, and as a result, jeopardizing your confidentiality and/or anonymity. Results will be addressed from DDT CO. Please initial here [________] to confirm understanding of this policy. Please include a self-addressed stamped envelope with your paperwork and samples.

Please note any special instructions for the notification of results:

___________________________________________________________________

Payment Method

Please indicate method of payment below. All payments must be in US funds.

Non-US clients please pay via credit card only to avoid testing delays.

In order to receive your results in five business days, payment must be made via money order or credit card. Payments made via personal check may take longer than five business days due to processing.

Confidentiality and Anonymity Instructions: Pay via money order and retain a copy for your records. Do not include a return address on your envelope.

[ ] Money Order

My money order is enclosed. Please make payable to DTT CO.

[ ] Visa or MasterCard

Your credit card will be discreetly billed as DTT CO or its affiliates. Choose between option 1 and 2 below. A signature of the EXACT name on the card is required for both options.

1. Pay by credit card via this form

Card number:

___/___/___/___/ ___/___/___/___/ ___/___/___/___/ ___/___/___/___/

Expiration Date: ___/___/

Card Verification Value Code (CVV): _____ (What is this?)

EXACT name on card:

_____________________________________________________________

EXACT address on statement:

Street: _______________________________________________________

City / State / Zip: _________________________/ _______/ ____________

I agree to pay the total amount according to Card Issuer Agreement (Merchant Agreement if Credit Voucher)

Signature of EXACT name on card:

_____________________________________________________________
PAYMENT CANNOT BE PROCESSED WITHOUT A SIGNATURE

2. Pay by credit card via our website

If you would prefer submitting your credit card information via our SECURE website, please visit http://www.testinfidelity.com/cc. To ensure the fastest possible routing of your case, your credit card will processed immediately once this form is submitted.

If you use our secure website to make a credit card payment, please fill-in you case reference below. You will receive your case reference from the secure website.

Case Reference: ______________________

I agree to pay the total amount according to Card Issuer Agreement (Merchant Agreement if Credit Voucher)

Signature of EXACT name on card:

_____________________________________________________________
PAYMENT CANNOT BE PROCESSED WITHOUT A CASE REFERENCE AND SIGNATURE

[ ] Check

My check is enclosed. Please make payable to DTT CO. Remember to sign your check.

Please do not send payment in cash.

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END OF TESTING FORM