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Purchase Order #
Company:
Date:
Contact:
Position:
Address:
City:
State:
Zip:
Phone:
Fax:
Ship To:
Same as Above
E-mail:
(needed to send tracking info)
Preferred Delivery Date:
If you want us to bill it to your overnight carrier, please list your account number and the name of the carrier:
We can bill you shipping. What method do you wish to use? (US Postage, Overnight, 2nd Day Air, 3rd Day Ground):
Product Description: Please let us know the exact product you wish to order by the name of the product and the number of drugs, and the amount of kits. Do you need collection cups? Let us know if you need Lab supplies such as Airbills, bags, or COC forms:
Please call us at 1-888-371-4615 if you have any doubt of the name of the specific products that you wish to order!
Contact Employee Screening Management at info@pre-screen.com or 1.888.371.4615 for additional information.
