Oral Rinse PCR Order Form

ORDER FORM: Oral Rinse PCR Tests

Home Test (1 Test per Box ) • Usually Ships within 24 hours
Your Name *

First Name Last Name
Business Name *
ABC Co.
Shipping Address *

Street Address

Street Address Line 2

City State

Zip Code
Email *
john@company.com
Phone Number *

Area Code Phone Number
Which USA Rapid Test Partner Referred You? *
ie. Joe, or ABC Co., or None

How Many Boxes of ORAL RINSE PCR Tests? *

1-49 Home Test Kits $ 145.00

$145 per test (includes Pre-paid Lab Shipping & Lab result via mobile App)

Quantity
Item subtotal: $ 0.00

50-99 Home Test Kits $ 135.00

$135 per test (includes Pre-paid Lab Shipping & Lab result via mobile App)

Quantity
Item subtotal: $ 0.00

Enter coupon

Subtotal $ 0.00 Shipping $ 0.00 Total $ 0.00

ORDER FORM: Oral Rinse PCR Tests