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Your Name *
Company Name *
Location Code  (if applicable)
Ship To:  Address *	Street Address must be a physical street address. NO P.O. BOXES
Work Phone *		City *
FAX		State/Province *
E-mail *		Zip/Postal Code *

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   (Available for Download)
EMPLOYEE BROCHURES (Download PDF - English)  / (Download PDF - Spanish)
NON-DOT EMPLOYEE BROCHURES (Download PDF)
SUPERVISOR'S BROCHURES (Download PDF)
NATIONAL HOTLINE/HELP LINE POSTERS (English) (Download PDF - English)  /  (Download PDF - Spanish)
DRUG AND ALCOHOL TRAINING DVD'S AND BOOKS  (Training DVD available online) / (PDF - Full Book) / (Verification Form Only)
HOW WOULD YOU LIKE THIS ITEM SHIPPED:   UPS Ground MAP (UPS.COM)	GROUND Next Day Air Early AM Next Day Air 2nd Day Air Early AM 2nd Day Air 3rd Day Select
PLEASE LIST YOUR NAME FOR OUR RECORDS *
ADDITIONAL SHIPPING/ORDER COMMENTS (Use this section to specify overnight shipping)
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. BE SURE TO CHECK YOUR KIT SUPPLY OFTEN. TO ENSURE THERE IS NO DELAY IN SHIPPING, MAKE SURE EACH STEP IS FILLED OUT. ALL ORDERS WILL BE SHIPPED VIA UPS (REGULAR GROUND).