ALPHA PRO SOLUTIONS FAX ORDER FORM Rev. …

1 ALPHA PRO SOLUTIONS FAX ORDER form Rev. 09/01/15. APS Web Based Training Courses Quantity Per Person Extended Price NOTE: One Password is needed for each individual. Price includes Course Password, Printable Docs, Final On-Line Exam, Printed Certificate and Continuing Ed Hours. BAT (New ____ Refresher ____) 5 Year Certificate $ $. Collector, DOT Urine (New ____Refresher ___) 5 Year Certificate $ $. Employee Drugs & Alcohol Awareness Training (DOT/Non-DOT) $ $. STT (New ____ Refresher ____) 5 Year Certificate $ $. Supervisor Recognizing Signs & Symptoms of Drugs & Alcohol $ $. DOT/Non-DOT.

2 APS Classroom PowerPoint & Videoclips Quantity Price Each Extended Price DOT Collector PowerPoint on CD with Videoclips $ $. (includes APS Instructor Training Manual). DOT Breath Alcohol Technician PowerPoint on CD with $ $. Videoclips (includes APS Instructor Training Manual). DOT Screening Test Technician PowerPoint on CD. $ $. (includes APS Instructor Training Manual ). Supervisor Signs (Drugs & Alcohol) PowerPoint with $ $. Videoclips (includes APS Training Manual). Employee (Drugs & Alcohol) PowerPoint $ $. APS Handbooks & Training Manuals (coincides with APS PowerPoint ). APS Help Handbook for Collectors, BATs & STTs $ $.

3 With Collector Scripts for Direct Observations Training Manual w/ On-Line Exam + Certificate $ $. Specify Qty Coll_____ BAT_____ STT ____ Supv ____ Empl ____. Training Manual $ $. Specify Qty Coll_____ BAT_____ STT ____ Supv ____ Empl ____. Employee Handbook $ $. Method of Payment Circle one: Mailing Check MC Visa AMX Specify Sub Total $. Prices 09-01-15. See APS website for current price & additional products and prices. Shipping and Handling Call for amount Shipping $. TAX 7% (for Florida Shipments Only) FL TAX 7% $. Add 3% Admin Fee for credit card purchase over $1000 TOTAL $. NAME ON CREDIT CARD _____SIGNATURE _____.

4 CREDIT CARD NUMBER _____ EXPIRATION DATE _____/_____. BILL TO EMAIL:_____PHONE:_____FAX:_____. BILL TO COMPANY _____. BILL TO STREET _____. BILL TO CITY _____ST _____ZIP_____. SHIP TO NAME_____ _____Email:_____(Required). SHIP TO COMPANY _____. SHIP TO ADDRESS _____. SHIP TO CITY _____ ST_____ZIP_____. SHIP TO PHONE_____FAX_____. Brought to you by ALPHA Pro SOLUTIONS , Inc. Internationally Recognized Drug Free Workplace Training, Consulting and Testing Devices & Supplies ALPHA Pro SOLUTIONS , Inc. Email: 17900 Hunting Bow Circle, Suite 102 Lutz, Fl 33548 Phone (800) 277-1997 or (813) 510-3912 Fax (775) 871-8538.

5 ALPHA PRO SOLUTIONS FAX ORDER form Rev. 09/01/15. Fax to APS: 775-871-8538 Call 800-277-1997. For Quote - DOT or Personal Breathalyzers Trade-In Allowance up to $ for old Breathalyzer Alcohol Test Screening Quantity Price Each Extended Price Alcohol Breath Tubes (Non-DOT BAC) (Min QTY 10) $ ea Alcohol Saliva Screening Test (DOT AlcoScreen02) (24/Box) $ Alcohol Saliva Swabs (DOT QED A-150) (10/Box) $ Alcohol Saliva Swabs (DOT QED A-150) (10 Boxes/Case) $ QC Solution for DOT QED A-150 (2 Vials/Box) $ Alcohol Testing Supplies Quantity Price Each Extended Price Alcohol Testing Forms: DOT _____ (100/Package) $ Alcohol Testing Forms.

6 Non-DOT _____ (100/Package) $ Alcohol Testing Forms: Customized with your Company Name Call For Pricing DOT Non-DOT (100/Package). Calibration Gas (34L Lightweight) $ Calibration Gas (105L Lightweight) $ Calibration Gas Regulator $ Calibration Logbook $ Evidence Tape EBT (2 rolls yellow tape/Box) $ Evidence Tape Collector Residue Free (250 Labels/Pack) $ Mouthpieces (EBT Type_____) (100/pkg) $ Mouthpieces (Lifeloc EBT Type_____) (250/pkg) $ Mouthpieces (Draeger_____) (100/pkg) $ Printer Labels for PermAffix Printer (140/Roll) $ Printer Labels for PermAffix Printer (Box of 4 Rolls) (140/Roll) $ Printer Thermal Paper (Lifeloc Thermalast) (4/pkg) $ Printer Paper 3-Ply (for DP Printers) (each)

7 $ Printer Paper 1-Ply (for RBT-IV Printer) (each) $ Printer Ribbon (Specify Printer Model_____) (each) $ Drug Test Kits and Supplies Quantity Price Each Extended Price Drug Test (Urine) 5-12 Panel Instant Cup (25/Box) Starting at $ Bluing Tablets (100/Bottle) $ Method of Payment Circle one: Mailing check MC Visa AMX. Prices 09-01-15. See APS website for current prices and additional products. Specify Sub Total $. Shipping and Handling Call for amount Shipping $. TAX 7% (for Florida Shipments Only) FL TAX 7% $. Add 3% Admin Fee for credit card purchase over $1000 TOTAL $. NAME ON CREDIT CARD _____SIGNATURE _____.

8 CREDIT CARD NUMBER _____ EXPIRATION DATE _____/_____. BILL TO EMAIL:_____PHONE:_____FAX:_____. BILL TO COMPANY _____. BILL TO STREET _____. BILL TO CITY _____ST _____ZIP_____. SHIP TO NAME_____ _____Email:_____(Required). SHIP TO COMPANY _____. SHIP TO ADDRESS _____. SHIP TO CITY _____ ST_____ZIP_____. SHIP TO PHONE_____FAX_____. Brought to you by ALPHA Pro SOLUTIONS , Inc. Internationally Recognized Drug Free Workplace Training, Consulting and Testing Devices & Supplies ALPHA Pro SOLUTIONS , Inc. Email: 17900 Hunting Bow Circle, Suite 102 Lutz, Fl 33548 Phone (800) 277-1997 or (813) 510-3912 Fax (775) 871-8538.