SELECTED FOR YOUR RANDOM? SCHEDULE YOUR TEST NOW RANDOM DOT SELECTION SCHEDULING RANDOM DOT SELECTION SCHEDULING Requestor's Name * First Name Last Name Company Name * Phone (###) ### #### Company Email * (If unknown, place personal email) Is the barcode with the location information being sent to the company email? * Yes, send to company email No, send directly to driver email Driver Email (If applicable) Donor Name * First Name Last Name Phone * (###) ### #### Date of Birth * MM DD YYYY CDL STATE * CDL LICENSE # * I Was selected for... * Random Drug Test Random Breath Alcohol Test Both Zip code for testing * Select the following * Invoice me, I have an account with an authorized card on file I Do not have an account, Pay Invoice Now I am the driver setting up my own test Under company account I am the driver responsible for the cost of the test, pay now Thank you!