Patch Purchase Order:
 
 
 
Organization Name:
Contact Person:
  
E-Mail Address:
  
Billing Address:
  
Billing City:
  
Billing State:
  
Billing Zipcode:
  
Phone Number:
  
Fax Number:
  
Shipping Address:
  
Shipping City:
  
Shipping State:
  
Shipping Zipcode:
How do you want to receive results?
Fax
Postal
   E-Mail
Attention To:
  
Fax Number:
  
Mailing Address:
  
City:
  
State:
  
Zip Code:
  
     
Order Information
   
Quantity
Unit Cost
Patch (sold in lots of 50, includes all applications and shipping materials, requires screen test or confirmation.)
$6.00
Screen Test
$16.00
Confirmations (applied to all positive screen tests)
$22.00
Frames
N/C
Chain of Custody
N/C
 
   
You will receive an email confirmation of your order. Minimum order 50 patches
Net 10 - Orders of 50 to 1000 -- Net 30 - Orders of 1000 or more
   
For credit card orders, please call (800) 355-6495
   
   

We gladly accept:
 
     
 

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Correctional Systems, Inc. and Sentencing Concepts, Inc. are wholly-owned subsidiaries of Cornell Companies, Inc.

©2001 SCI Concepts Inc., A subsidiary of Correctional Systems, Inc.