COMPLIANCE ACCOUNT SET-UP START YOUR ACCOUNT TODAY(TERMS & CONDITIONS) REFFERAL: JOANNE BACOURT REFFERAL: JOANNE BACOURT Name of DER * (Designated Employee Representative) First Name Last Name Phone (###) ### #### Email * Company Name * How many drivers? * DOT NUMBER * Create a (ONE) word discount code for your drivers to use for online scheduling (This is for a 15% Discount: up to 10 letters please) Physical Address * (must be a physical address not a PO box) Address 1 Address 2 City State/Province Zip/Postal Code Country Is your mailing address the same as your physical address? * Yes No If NO, Put your mailing address here: Select the following * (By setting up an account, you will receive a call to have a credit/debit card on file) Set up an account to get monthly invoicing Pay upfront for each test My drivers will pay for their own test Haven't decided yet Select all that apply * Schedule a test now call me Email me I will schedule a test in the near future Services Needed * All DOT Services CDL Physical DOT Drug Testing Breath Alcohol DOT Policy Random testing Post Accident MVR Other Are you in need of a DOT Policy * The Department of Transportation (DOT) mandates that you put in place a drug and alcohol policy as soon as your company hires its first driver. YES I already have a policy in place NO, I agree to Opt Out , & understand I have been informed about a policy By Precision Mobile Lab Testing Additional information I Agree to terms and conditions * I Agree Thank you!