DOT Files with Drug & Alcohol Consortium

Note: DOT Files Starts at $500/year (includes DOT files setup + drug & alcohol consortium enrollment; does not include testing fees or other state/federal charges)

Legal Business Name: *

Doing Business As:

DOT Number: *

MC/MX Number (if applicable):

Primary Contact Name: *

Title / Role:

Contact Phone Number *

Contact Email Address *

Business Address *

Service Details

Are you a new DOT carrier or existing carrier? *

New DOT Carrier (need initial setup)

Existing DOT Carrier (need to join consortium)

Type of Service Needed (Select one or more): *

New DOT Filing + Drug & Alcohol Consortium Enrollment — $500/year
Annual Renewal — $400/year
Add Driver to Consortium — $75 per driver
Remove Driver from Consortium — No fee
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Number of Drivers in Your Company: *

Driver(s) Testing Location Preference: *

Nearest FMCSA-certified testing site
Mobile testing (if available)
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Do you require assistance with driver list management? *

Yes
No
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Do you currently participate in a Drug & Alcohol Testing Program? *

Yes
No
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If yes: Name of Current Consortium/TPA

If yes: Do you need assistance transferring records?

Option 1
Option 2
Option 3
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Do you need assistance with the follow?

Random Drug Test
Random Alcohol Test
No, not at this time
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Driver Information for Consortium

Complete for each driver being enrolled; attach additional sheet if more than 3 drivers

Driver #1 Details Below

Driver 1 Full Name:

Driver 1 Date of Birth:

Driver 1 License Number & State:

Driver 1 Last 4 Digits of SSN:

Driver 1 Phone Number:

Driver 1 Email Address:

Driver #2 Details Below

Driver 2: Full Name:

Driver 2: Date of Birth:

Driver 2 License Number & State:

Driver 2: Last 4 Digits of SSN:

Driver 2 Phone Number:

Driver 2 Email Address:

Driver #3 Details Below

Driver 3: Full Name:

Driver 3: Date of Birth:

Driver 3 License Number & State:

Driver 3: Last 4 Digits of SSN:

Driver 3 Phone Number:

Driver 3 Email Address:

Supporting Documents

Please upload clear copies of the following: