Alco-Tube Plus Corporate Order Form - Part I

Thank you for helping us dethrone the #1 preventable health hazard in the United States.

Please fill out the form below so that we can ship your breath testers promptly. If you have any questions, please call us at (212) 726-5704 or contact us through our online form.

PRICING (does not include $15.00 shipping and handling, FOB Montreal, Canada per order):

100 - 999 tubes	$6.50 each plus $15.00 shipping and handling per order (FOB Montreal, Canada)
1,000 - 9,999 tubes	$5.70 each plus $30.00 shipping and handling per order (FOB Montreal, Canada)
10,000+ tubes	Please call (212) 726-5704

How many Alco-Tube Plus tubes would you like to order (minimum order 100 tubes)?