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※