Do Not Use this form to place an order on line.
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You may email an order to firstname.lastname@example.org
Or call toll-free 1-866-525-8208 for quantity discounts.
US DRUG TESTING
168 DEER RD RICHMOND HILL, GA 31324
PRODUCTS: Order in even lot quantities. For example: 1 box = 25 each. 2 boxes = 50 each.
Item Code Description (optional) Qty Ea. X Price Ea. = Total Amt. Back to Products Page
North Carolina organizations add 7.5% sales tax (.075 X Sub Total)
UPS shipping & handling charges will be added to your order. UPS ground service takes between 3 -4 days. If you need faster delivery, please call and tell us which service you want.
PURCHASE ORDER #
Purchasing Contact Email
Billing Address: Street or PO Box City Zip
Send invoice via: Email Fax Mail
Accounts Payable Contact Email
Delivery Address: (Must be a physical address, UPS does not deliver to P.O. boxes).
Street City Zip
Contact Person Email
CREDIT APPLICATION for 1st time buyers
NOTE: Our terms are a STRICT 30 days net. Number of years in business:
Describe your business:
Provide three trade references (Companies that currently sell to you on open account).
1. Company Name: Address:
Contact Person: Ph# Fax#
2. Company Name: Address:
3. Company Name: Address:
GENERAL PROVISIONS FOR EXTENSION OF CREDIT
This application and the information contained herein is a request for the extension of credit for commercial business use only and each applicant certifies that the firm he represents is doing business as a Corporation , Partnership , or Sole Proprietorship (check one). Each applicant authorizes the above named Creditor to obtain written or oral credit reports from any credit reporting agency. Each applicant further authorizes any bank or commercial business with whom the applicant is doing or has done any type of business to give any and all necessary information to the Creditor which will assist Creditor in the credit investigation. Each applicant further authorizes the Creditor to investigate the applicant's credit status from time to time as the Creditor deems necessary and should Creditor upon such reinvestigation deem it necessary to limit or terminate the credit arrangement with applicant, said applicant shall be notified as to any adverse action. Upon approval of this application for credit, said applicant will be notified regarding the Creditor's terms of sale and should applicant at some future time deviate from the Creditor's terms of sale, said Creditor reserves the right to terminate future extension of credit with applicant.
If credit is extended, I (we) agree to pay Creditor all debts incurred within Creditor's terms of sale. I (we) expressly waive all right to exemption under the constitution and laws of any state, as to personal property and I (we) agree to pay all costs of collecting or attempting to collect or secure any and all debts which I (we) now owe or which I (we) may in the future owe Creditor for goods sold to me (us) or for services rendered including any and all attorney's fees on the unpaid debt as long as any of said indebtedness is due and unpaid. I (we) also agree to pay a FINANCE CHARGE OF 1 1/2 PERCENT PER MONTH (ANNUAL PERCENTAGE RATE OF 18%) on any unpaid past due balance. Creditor is hereby authorized to deliver goods or perform services for the following at my (our) request and charge said goods or services to my (our) account and this shall continue until written notice to the contrary is given and accepted, which acceptance shall be evidenced by signature of Creditor.
Name of Authorized Person applying for credit Title Date