Order Chain of Custody Forms

Requester Name: *
E-mail Address: *
Requester Phone: *
Company Name: *
Location / Department *
Mailing Address (No PO Boxes for FedEx): *
Address 2:
City: *
State: *
Zip Code: *
Quantity needed:
Urinalysis (DOT/Dept of Transportation):
Method of Delivery: *US Postal Service (no charge)
FedEx Overnight - AM Delivery
FedEx Overnight - PM Delivery
FedEx 2nd Day Delivery
FedEX Saturday Delivery
FedEx Billing Number:
Other comments or special instructions:

If no FedEx number is given, we will bill all FedEx charges on your regular invoice.

If you are in the Dallas area and would like same day delivery via courier, please call us to make arrangements - 972-701-8603.

Note: Orders received after 3:00pm CST will be processed the next business day.

* Required