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FAX / Mail Order Form
Ordering through the internet is the fastest way to process your shipment. If you would prefer to send us a FAX order, please download the form below. Print and fill out the form, then FAX it to us at 201-943-8828. All appropriate fields must be filled, or your order may not be processed.
If you plan to order using check payment via physical mail, please use this FAX order form and include it with your mailed check.
Breathalyzer FAX Order Form (PDF format) Right-click to Save to Your Computer
Note: If you are a distributor or reseller, use the Distributor page instead.