test-form-june-12 Loading... Which brand of strips do you want to sell (select one)? * Accu-Chek Aviva Plus Accu-Chek Compact Contour Contour NEXT Freestyle Freestyle Lite One Touch Ultra Smartview Verio Blue Verio White How many Accu-Check Aviva Plus boxes do you have? 50 strip boxes: 100 strip boxes: How many Accu-Check Compact boxes do you have? 51 strip boxes: 102 strip boxes: How many Contour boxes do you have? 50 strip boxes: 100 strip boxes: How many Contour NEXT boxes do you have? 50 strip boxes: 100 strip boxes: How many Freestyle boxes do you have? 50 strip boxes: 100 strip boxes: How many Freestyle Lite boxes do you have? 50 strip boxes: 100 strip boxes: How many One Touch Ultra boxes do you have? 50 strip boxes: 100 strip boxes: How many Smartview boxes do you have? 50 strip boxes: 100 strip boxes: How many Verio Blue boxes do you have? 50 strip boxes: 100 strip boxes: How many Verio White boxes do you have? 50 strip boxes: 100 strip boxes: Total50 Total100 TotalQuantity * Note: our minimum order quantity is 200 test strips. Subtotal Next Step Radio 0 1 Are all boxes sealed? * Yes No Sorry, we currently accept only sealed boxes. Is the expiration date on all boxes at least 6 months from today? * Yes No Sorry, we cannot accept expired strips. Please enter your contact information to receive your payment. First Name * Last Name * Email * Phone Number How do you prefer to be contacted? EmailPhone Once we receive and verify your order, how do you want to receive payment? PayPalCheck by Priority Mail Paypal Email Would you like us to send you a free postage-paid mailing label or mailing kit? Mail a Box and Return Label (5-7 days) (We provide shipping box)Email Post Office Return Label (1 day) (Ship in your own box)Email United Parcel Service (UPS) Return Label (1 day) (Ship in your own box)No thanks Address * * * StateALAKAZARCACOCTDEFLGAHIIDILINIAKSKYLAMEMDMAMIMNMSMOMTNENVNHNJNMNYNCNDOHOKORPARISCSDTNTXUTVTVAWAWVWIWY * Do you have any additional questions for us? * Note: our minimum order quantity is 200 test strips. Previous Step You'll receive: $0 * Required
