Saliva Alcohol Screening Test for Blood Alcohol Concentration

Alco-Screen and Alco-Screen O2 Order Form

The minimum order for the the Alco-Screen is 6 tests at $1.75 per individually foil wrapped test. Minumum order for the Alco Screen O2 (DOT Approved) is 6 tests at $2.00 per individually foil wrapped test. To order call TOLL FREE 1.877.2DRUG TEST (1.877.237.8483). Download an order form for the Alco Screen and Alco Screen O2 saliva alcohol tests. You will need the free Adobe Acrobat Reader Software to view and print the file. Secure, confidential online ordering.
QTY	DESCRIPTION	PRICE EACH	AMOUNT
	6 Alco-Screen Tests	$10.50
	1 BOX (24 Tests Alco-Screen Tests)	$40.00
	6 Alco-Screen O2 (DOT Approved)	$12.00
	1 BOX (24 DOT Approved Alco-Screen O2 Tests)	$44.00
		Ohio Residents Add 6.75% Sales Tax
		(MINIMUM) SHIPPING	$4.95
		TOTAL

NOTE: Overseas shipping costs will be calculated at the time the order is filled.

(Please print clearly or type.)

Name___________________________________________________

Street Address___________________________________________

City_____________________________________________________

State/Province____________________________________________

Postal Code______________________________________________

Country__________________________________________________

Phone___________________________________________________

Email address____________________________________________

Payment Method(Visa or Mastercard only)____________________

Credit Card # __/ __/ __/ __/ __/ __/ __/ __/ __/ __/ __/ __/ __/ __/ __/ __/

Expiration Date____/____/____/______Signature on Card___________________________ Ohio residents add 6.75% sales tax. All prices quoted are in US dollars. PRICE SUBJECT TO CHANGE WITHOUT NOTICE. Fax this form, or call: Expomed Inc., P.O.Box 186, Munroe Falls, Ohio 44262 U.S.A. Tel 330.926.0860, Fax 330.923.4814
Return Policy:Expomed will replace all defective product. All goods must be returned within 30 days from the date of purchase. There is a 20% restocking fee for items ordered in error. All manufacturer warranties apply. No personal information is sold or given to third party companies.

Secure, confidential online ordering