Drug Use Is Life Abuse - Events Calendar

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 *