Beat drug test!

Complete All Information, Print Form, Then Mail This Form To:

P-D-T.Com
1980 Edgemere Drive
Rochester, NY 14612

Shipping Information

Name & Shipping Address:
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street address, city,
state and zip code.

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E-Mail Address:

Credit Card Information (If Paying By Credit/Debit Card)

Visa/MasterCard/Amex/Discover #:

Visa/MasterCard/Amex/Discover Expiration Date:

Product Description
Instant Clean Add-It-Ive	$35 + $9.95 S&H Quantity:
Spike Additive	$125 + 9.95 S&H Quantity:
Sub Solution	$50 + $9.95 S&H Quantity:
Hair Follicle Shampoo	$45 + $9.95 S&H Quantity:
Rescue Cleanse 16 oz. Detox Drink (Watermelon Flavor)	$40 + $9.95 S&H Quantity:
Rescue Cleanse 20 oz. Detox Drink (Cran-Apple Flavor)	$45 + $9.95 S&H Quantity:
Green Clean Apple Concentrate	$45 + $9.95 S&H Quantity:
Ultra Wash (Saliva)	$45 + $9.95 S&H Quantity:
Oral Clear Gum (Saliva)	$90 + $9.95 S&H Quantity:
Quick Flush Capsules	$30 + $9.95 S&H Quantity:
Single Test Panel	$20 + $9.95 S&H Quantity:
Five Panel Test Kit	$25 + $9.95 S&H Quantity:
Pre-Cleanse Herbal Formula	$20 + $9.95 S&H Quantity:
Incognito Belt	$125 + $9.95 S&H Quantity:
Value Packs -	+ $9.95 S&H

We conveniently accept all forms of payment including checks, money orders, etc. Personal checks normally take up to 2 weeks to clear. Send a cashier's check or a money order for faster turn-around time. Make all payments payable to CleavOnline.Com. You can also mail us your credit card information if you are worried about using it online as many people are.

Can't print this form? Write us a note or email your name/address here and we'll send one to you!

Passing-Drug-Test.Com is a proud authorized distributor of Clear Choice beat drug test products.

Shipping Prices
Rush S&H OverNight S&H	NON US Orders
Rush $14.95 / OverNight $30 (If Applicable)	Add $8 (If Applicable)

Total Cost (USD) Non US Orders: Add $8 to your payment.