ORDER INFO
TechNow, Inc. Clinical Laboratory

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INTERCEPT®
ORAL FLUID DRUG TESTING
URINE DRUG TESTING
METHADONE &
DRUG-FREE PROGRAMS
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FAQ'S
TECHNOW, INC. FAX / MAIL-IN ORDER FORM

DIRECTIONS: Print out, fill out, and fax to 610-362-0614 or mail this form with your check or money order to: TechNow, Inc.; 31 Industrial Highway; Essington, PA 19029.
You can also place an order by calling us at 610-362-0610.

Name: _________________________________________________
Address: _______________________________________________
City, State, Zip: _____________________________________
Phone: ___________________________________
FAX: _____________________________________

*as soon as your check clears, we will send your results.

DESCRIPTION QUANTITY
(number of drugs checked)
PRICE
per kit
SUBTOTAL
INTERCEPT® ORAL FLUID DRUG TEST COLLECTION KIT
(check drugs)
Amphetamines/Methamphetamines
Barbiturates
Benzodiazapines
Cocaine
Marijuana
Methadone
Opiates
PCP
_________ x $5/drug= _________
URINE DRUG TEST COLLECTION KIT
(check drugs)
Alcohol
Amphetamines / Ecstasy
Barbiturates
Benzodiazapines
Cocaine
Marijuana
Methadone / EDDP
Opiates
PCP
Propoxyphene
_________ x $4/drug= _________
Total _________
 
U.S. shipping:
Choose how you would like us to send you the kit:

Regular Mail (2-3 day delivery): $5.00
or Express Mail (overnight delivery): $25.00
or Overnight Saturday Delivery: $35.00

+shipping _________
Grand Total _________

Please circle the method in which you would like your report sent to you:

FAX   |   MAIL (REGULAR)

All results are confidential. Our report will contain no names and will be identified by number only.

Questions? e-mail us at info@technowlab.com.