Application Form

Fill out the application below then Proceed to Ordering for online ordering. You may email sales@compliancecore.com with any questions or contact us toll free at 888-464-4784 for large quantity pricing and ordering. You will be invoiced for payment.

Online Pricing is Introductory prices for new customers. Call us for volume prices 888-464-4787

 

Company Name

(if applicable)

 

Your name/Title:

 

Corporate officers Names and Titles (if applicable):

             

Name / Title                                                                                                       Name ./ Title

 

Billing Address:

Enter street address  

 

Shipping Address (if different than above)   :

Enter Shipping Address if different than above

 

 

Years in Business:   

 

Billing Telephone: (xxx-xxx-xxxx)        Billing Fax: (xxx-xxx-xxxx)

Order Contact Telephone :                Order Contact Fax:

 

Email address:

 

Website:

 

           

 

**For Testing Systems call our sales office for details and to set up the service for your company or school**

 Drug Testing Systems must be order by faxing a completed application above to Compliance Core. We will contact your office to set up your account with us and the SAMHSA Lab.

 

Compliance Core  3410 Ridgewood Avenue  Ashtabula, Ohio  44004

888-464-4787       fax 775-206-7639

www.compliancecore.com