Online Supply Order Form

At-Need SecuriGene DNA Banking Kits

Free (consignment)
For customized kits, or to order in bulk, please indicate on your request in the comment section below.

Pre-Need SecuriGene DNA Banking Kits

Free (consignment)

DNA Banking Brochure

Free – Bundle of 30 per order

DNA Banking Authorization Forms

Free – Pad of 25 sheets per order

Extra Shipping Packs

Free – Includes Prepaid Waybills

Brochure Holder


Sample DNA Capsule

$75 Deposit

White LCD TV Display

Includes 1 Sample DNA Capsule
$130 Deposit*

Black LCD TV Display

Includes 1 Sample DNA Capsule
$130 Deposit*
*All deposit items can be returned back to SecuriGene for a full refund at any time. An invoice will only be issued to your funeral home for LCD TV Displays or sample capsules ordered. All other items above are free.

Please fill out the information below to complete your order:

Thank you!
Your supply order request has been successfully submitted.

You will receive an email with the tracking number for your shipment within one business day. If you do not receive it, please email or call us at 1 (877) 714-6359.

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