Lineage DNA Test Order Form

Thank you for choosing DNA Diagnostics Centre. Please complete the form below to purchase an ancestry DNA test. All transactions made through this form are secure. If you have any questions, please call customer service at 0845 408 2084.

Fields marked with * are required. Your information will be held strictly confidential. Click here to view our Privacy Policy
Order Information:
Title*:	Mr Ms Mrs Miss
First Name*:
Last Name*:
Email Address*:
Telephone:
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Lineage Test Options
0 1 2 3 4 5	£109 Maternal Lineage Test (mtDNA sequencing, includes HVI, II, and III)
0 1 2 3 4 5	£89 Paternal Lineage Test (Y-STR, male sample required)
0 1 2 3 4 5	£179 Dual Lineage Test (mtDNA and Y-STR, male sample required)
Total Test Fee:
Credit or Debit Card Information
First Name*:
Last Name*:
Card Type*:	Solo Switch/Maestro Visa/Delta/Electron MasterCard/Eurocard
Credit Card Number*:
Expiry Date*:	Month 01 02 03 04 05 06 07 08 09 10 11 12 Year 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020
Card Security Code*:
Start Date:	Month 01 02 03 04 05 06 07 08 09 10 11 12 Year 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008
Issue Number:
Shipping Information:
Please fill in the address where you would like the testing kit and results to be sent. If you want to send this as a gift, enter the recipient's address here, otherwise, use your own address.
Recipient's Name*:
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Results Information:
Mail 0 1 - Free 2 3 4 5 6 copy(ies) of the result to the recipient's address            above. The first copy is free of charge. Each additional copy is £10.
Send results electronically to the recipient's email above.
Both mail and email.
Extra Information:
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