Purchase Form
Please fill out the Below Form, so that we may send you your order.
NO PO BOXES PLEASE.
TESTS TO PURCHASE:
Instant Alcohol / Saliva Test Strips - $3.00
Qty:
On-Site Oral / Substance Abuse Screening Device - $10.00
Qty:
Shipping & Handling
$2.00
TOTAL:
 
SHIP TO ADDRESS:
Name:
Ship to Address 1 :
Ship to Address 2 :
City:
State:
Zip:
Phone Number:
E-mail Address:
   

PAYMENT:

Routing # :
View Sample Check
Account # :
Check # :
Account Holder Name :
* Shipment will be approximately 10-14 days from receipt of order *
* to make sure checks have cleared the bank *
 
 


 

Drug Use Is Life Abuse | P.O. Box 1002 | Minden, NV 89423 |
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