Environmental Shop
**note to cancel your order request hit your web browsers back button or close this window.**
Water Testing Order Form
You are purchasing a Water Testing Kit from Dakota County, Minnesota. Please fill out the information below to complete your application order. After completing the form, click the "Place order" button at the bottom. You will receive a confirmation number once the order has been submitted and your credit card has been charged.
How did you hear about the water testing service (Please Select One)
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Mail/Flyer
Online Search
Friend/Family
County Staff
Well Driller or Other in Well Industry
Social Media
Other:
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Reason for Test (Please select one)
Routine
Retest
Refinancing
Property Sale / Transfer
Repair
Daycare
Shipping Information
First Name:
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Last Name:
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Address
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City
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State
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Zip
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Contact Phone Number
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E-Mail Address
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Available Kit Information
Select the items you'd like to include in your kit, each chemical is $21.00.
Coliform bacteria $21.00
Nitrate $21.00
Manganese $21.00
Arsenic $21.00
Lead $21.00
Fluoride $21.00
Select a Kit Return option.
Sample Return Shipping
Sample Drop off
Google Maps Directions to Western Service Center
Driving Directions
Total Fee
*Note: To order another kit please return to home page.
Payment Information
Payment form
Credit Card
Credit Card Type
MasterCard
Visa
Credit Card Number
Enter number only no dashes.
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CVC
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What is a
CVC Code
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Credit Card Expiration
MM
1
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YYYY
2023
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2035
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2041
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Cardholder same as Owner?
Cardholder First Name
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Cardholder Last Name
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Cardholder CompanyName
Address
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City
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State
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Zip Code
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Phone Number
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Release Version 17.09 January 04, 2023
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