Drug Test Signup

Fill The Below Form

Company Name

Registered Office Address

DOT No.

Phone

Email

Fax

Contact Persons' Names (To release the confidential drug test report)

Name

Title

Phone

Email

Confidential Fax

Name

Title

Phone

Email

Confidential Fax

No. of Drivers

Start Date for Random Test Program

I/We understand that upon filling the application we are liable for monthly random program charges. I also acknowledge the receipt of price lists and the list of my duties and responsibilities as employer as per US DOT rules & regulations. I/We understand that it would be our responsibility to inform you when ever the employees quit the job or there are drug/alcohols charges initiated against the employees in Writing.

I acknowledge that I have read and agree to the Terms & Conditions and Privacy Policy