DOT CONSORTIUM ENROLLMENT ENROLLMENT IS PER DRIVER IN YOUR COMPANY NOT THE COMPANY BY ITSELF DOT CONSORTIUM ENROLLMENT FORM DOT CONSORTIUM ENROLLMENT FORM DER (Designated Employee Representative) * First Name Last Name Company Name * DER Contact Phone # * (###) ### #### Email * Registered DOT Number # * Number of Drivers Drivers that need enrollment (Add driver full name, CDL # & State, DOB per line or you can send us a spreadsheet with the following information) Company Physical Address (Cannot be a PO Box, must be the physical address registered for your DOT Company) Address 1 Address 2 City State/Province Zip/Postal Code Country Is the mailing address same as the physical address? * (If not, provide below) Yes No Mailing address if different from above In order to finalize the enrollment, a payment must be made upfront * I AGREE Thank you!