DOT Drug & Alcohol Testing Consortium Enrollment Step 1 of 3 33% Company InformationOperation Type* Owner/Operator Corporation Partnership Sole Proprietor LLC Federal Agency* FMCSA FAA FRA FTA PHMSA USCG How did you hear about us?Company Name*Owner's Name* First Last Designated Employer Representative (DER) Name* First Last DOT #*Mailing Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Business Phone Number*Cell PhoneEmail* How did you hear about X-celerated?ReportingA Medical Review Officer (MRO) is responsible for reviewing and releasing the drug test result. We offer three convenient reporting methods. Select one only*Fax ReportingSmartVault Reporting (Sends notification to your email)Fax NumberEmail Address for Reporting Results Fees and PaymentYour card will be kept on file and only processed for the initial annual consortium fee and drug or alcohol tests as they are completed. Credit Card Visa MasterCard AMEX Discover Credit Card NumberCard Holder Name First Last Exp. DateSecurity CodeSignature*With my electronic signature, I am authorizing Premier Screenings to charge my credit card for the enrollment fee. Add Your DriversIf you have previously been enrolled in a consortium program or had another drug testing service, it is a DOT regulatory requirement that you provide proof of previous negative test results and previous consortium enrollment.Active Drivers*NameSocial SecurityDate of BirthHire Date Click the + to the right to add more drivers. Contact Us Today Monday - Friday/Saturdays 9:00am - 5:00pm Services By Appointment Only 1417 N. Semoran Blvd., Ste 115 Orlando, FL 32807 Call 407-374-2757 ***Available After-Hours ***In & Out in 15 Minutes ***24/7 Mobile Services Most RequestedPaternity DNA Testing Driver Records (MVR) DOT Pre-Employment Drug Test Level 2 Background Check Criminal Background Check Probation Drug Test
