Name Street Address Location Code (if applicable) Street Address must be a physical street address. NO P.O. BOXES Organization Address (cont.) Work Phone City FAX State/Province E-mail Zip/Postal Code
Street Address must be a physical street address. NO P.O. BOXES
KIT ORDER SECTION - Questions? [ENTER QUANTITY. EX. 6,24,50 or Other] DOT DRUG KIT ? NON-DOT DRUG KITS ? DOT BREATH ALCOHOL KITS ? NON-DOT BREATH ALCOHOL KITS ? DOT POST-ACCIDENT D/A KITS NON-DOT POST-ACCIDENT D/A KITS CLIENT REQUIRED DRUG/ALCOHOL KITS ? CLIENT REQUIRED ALCOHOL KITS ONLY ? BROCHURES ORDER SECTION [ENTER QUANTITY. EX. 6,24,50 or Other] EMPLOYEE BROCHURES (English) (Available in PDF) EMPLOYEE BROCHURES (Spanish) (Available in PDF) SUPERVISOR'S BROCHURES NATIONAL HOTLINE/HELP LINE POSTERS (English) NATIONAL HOTLINE/HELP LINE POSTERS (Spanish) DRUG AND ALCOHOL TRAINING DVD'S AND BOOKS (Training DVD available online) ADDITIONAL SHIPPING/ORDER COMMENTS: NOTICE: UPS Ground service is provided at no cost. Shipping and Handling will be charged to your company for all other priority shipping services. NOTICE: Orders may be processed the following day. PLEASE UTILIZE THIS ONLINE FORM WHEN ORDERING ADDITIONAL KITS. ALSO BE SURE TO CHECK YOUR KIT SUPPLY OFTEN. WHEN YOUR SUPPLY OF KITS IS LIMITED TO A MINIMUM OF SIX (6) EACH. TO ENSURE THERE IS NO DELAY IN SHIPPING, PLEASE USE THIS FORM. MAKE SURE EACH STEP IS FILLED OUT. ALL ORDERS WILL BE SHIPPED VIA UPS (REGULAR GROUND).
PLEASE NO PHONE ORDERS!! If you have any questions, please contact Yolanda Shipping office: 620.669.4421 fax:620.669.4493
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5, 7 & 9 Compound Drive | Hutchinson, KS 67502 | P: 1.800.294.8758 | F: 620.669.0906