<% Option Explicit Dim FieldEmptyError Dim EmptyFieldMarker Dim Message Dim TheNewUrl if not isempty(Request.form("submit")) then if Request.Form("busname") ="" or _ Request.Form("buyers") ="" or _ Request.Form("address") ="" or _ Request.Form("bustype") ="" or _ Request.Form("city") ="" or _ Request.Form("state") ="" or _ Request.Form("zip") ="" or _ Request.Form("phone") ="" then FieldEmptyError = True if not FieldEmptyError then TheNewUrl= "busname=" & Request.Form("busname") &_ "&buyers=" & Request.Form("buyers") &_ "&name=" & Request.Form("name") &_ "&address=" & Request.Form("address") &_ "&bustype=" & Request.Form("bustype") &_ "&city=" & Request.Form("city") &_ "&storenum=" & Request.Form("storenum") &_ "&state=" & Request.Form("state") &_ "&zip=" & Request.Form("zip") &_ "&taxid=" & Request.Form("taxid") &_ "&phone=" & Request.Form("phone") &_ "&busyears=" & Request.Form("busyears") &_ "&fax=" & Request.Form("fax") &_ "&brands=" & Request.Form("brands") &_ "&email=" & Request.Form("email") &_ "&brandlist=" & Request.Form("brandlist") &_ "&website=" & Request.Form("website") response.write(TheNewUrl) Response.redirect("retailers_new_store_process.asp?" & TheNewUrl) else EmptyFieldMarker="*" Message="* Please fill in all the required fields." end if end if %> Health Tech
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Drug testing is a serious situation for many people. When your customers are confronted with a drug test, they need complete assurance that the detox product they purchase from your store will work. Your employees need to be confident that the detox product they are recommending is reliable and effective. Health Tech understands the stress that a customer experiences when they are faced with a drug test and we are dedicated to helping!

Since 1993, millions of Clear Choice® detox products have used by satisfied customers throughout the United States, Canada, and Europe. The Clear Choice® product line has been featured in thousands of stores across the country and internationally. Health Tech has built its reputation on reliability and offers its original “200% Double Your Money Back Guarantee!” on all of the Clear Choice® products.

As a retailer, you can help the fight against the abuses of drug testing by offering your customers Clear Choice®, the most trusted brand of testing solutions. When your customer’s freedom, right to privacy, or job is at stake, don’t depend on cheap and inferior imitations - “There’s only ONE Clear Choice®!”

For wholesale information, complete the following Authorized Dealer Application and a wholesale account executive will contact you on the next business day.

Business Name:

" size="20" maxlength="30"> <% if FieldEmptyError and Request.Form("busname")="" then Response.Write(EmptyFieldMarker)%>

Buyers Name:

" size="20" maxlength="30"> <% if FieldEmptyError and Request.Form("buyers")="" then Response.Write(EmptyFieldMarker)%>

Contact Name:

" size="20" maxlength="30">



" size="20" maxlength="30"> <% if FieldEmptyError and Request.Form("address")="" then Response.Write(EmptyFieldMarker)%>

Business Type:

" size="20" maxlength="30"> <% if FieldEmptyError and Request.Form("bustype")="" then Response.Write(EmptyFieldMarker)%>


" size="20" maxlength="30"> <% if FieldEmptyError and Request.Form("city")="" then Response.Write(EmptyFieldMarker)%>

Number of Stores:

" size="20" maxlength="30">


" size="1" maxlength="2"> <% if FieldEmptyError and Request.Form("state")="" then Response.Write(EmptyFieldMarker)%>    Zip: " size="3" maxlength="10"> <% if FieldEmptyError and Request.Form("zip")="" then Response.Write(EmptyFieldMarker)%>

Tax Id#:

" size="20" maxlength="30">


" size="20" maxlength="30"> <% if FieldEmptyError and Request.Form("phone")="" then Response.Write(EmptyFieldMarker)%>

Years in Business:

" size="20" maxlength="2">


" size="20" maxlength="30">

Does your store carry other detox brands? (Y/N): ">


" size="20" maxlength="30">

If yes please list the brands:


" size="20" maxlength="30">

<% Response.Write(Message) %>  

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