DOT Drug & Alcohol Testing Consortium Enrollment Step 1 of 3 33% Company Information Operation 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 Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Armed Forces Americas Armed Forces Europe Armed Forces Pacific State ZIP Code Business Phone Number* Cell Phone Email* How did you hear about X-celerated? Reporting A Medical Review Officer (MRO) is responsible for reviewing and releasing the drug test result. We offer three convenient reporting methods. Select one only* Fax Reporting SmartVault Reporting (Sends notification to your email) Fax Number Email Address for Reporting Results Fees and Payment Your 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 Number Card Holder Name First Last Exp. Date Security Code Signature* With my electronic signature, I am authorizing Premier Screenings to charge my credit card for the enrollment fee. Add Your Drivers If 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* Name Social Security Date of Birth Hire Date Click the + to the right to add more drivers. Contact Us Today Monday - Friday/Saturdays 9:00am - 5:00pm Services By Appointment Only Call ***Available After-Hours ***In & Out in 15 Minutes ***24/7 Mobile Services Most Requested Paternity DNA Testing Driver Records (MVR) DOT Pre-Employment Drug Test Level 2 Background Check Criminal Background Check Probation Drug Test