application form

Process of the order of water crystal experiment
  • After the submission of the application form, we will contact you by email and we will ask you make the payment either via international bank transfer or Paypal.
  • After the payment is confirmed, please send a water sample(s) to us. Please make sure to wrap aluminium foil around the water bottle to protect information inside of the water.
  • Please note that it may take 2 weeks to 3 months depending on how busy our laboratory is.

Fill in the blanks below, check the agreement box and click SEND.
are requested must.

Company Name
Person in Charge
Mailing Address
Phone
FAX
E-MAIL
Number of Samples
The purpose of the water crystal experiment
Explanations of your water sample