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Business Account Setup & Employer Services Request Form

COMPANY INFORMATION

Business Type
Industry

PRIMARY CONTACT

Preferred Contact Method
Phone
Email
Text Message

BILLING CONTACT

Is billing handled by the same person listed above?
Yes
No

SERVICES NEEDED

Which services are you interested in?
Are you regulated by DOT?
Yes
No
If Yes: DOT Agency
Are you currently enrolled in a consortium?
Yes
No
Need assistance transferring to a new consortium?
Yes
No

RANDOM TESTING PROGRAM

Do you currently have a random testing program?
Yes
No

MOBILE TESTING

Interested in Mobile Testing?
Yes
No
Frequency Needed

CLEARINGHOUSE SUPPORT

Do you need assistance with FMCSA Clearinghouse requirements?
Yes
No
If YES:

ACCOUNT SETUP DETAILS

Anticipated Testing Volume Per Month
How Did You Hear About Us?

ADDITIONAL INFORMATION

Contact

205-460-1080

205-460-1083

5280 Old Springville Rd Ste 200 Pinson, AL 35126

Hours

Mon - Fri

8:00 am - 5:00 pm

Saturday

10:00 am - 3:00 pm

Sunday

Closed

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Professional Testing, Screening, and Diagnostic Solutions for Individuals, Employers, Attorneys, and Healthcare Providers.

Quick Links

Home

About Us

Schedule Appointment

Employer Services

Request Mobile Testing

Services

Drug & Alcohol Testing

DNA Testing

Mobile Testing

Background Checks

Fingerprinting

Wellness Testing

Employers

Employer Services

DOT Testing

Consortium Program

Random Testing

On-Site Collections

Contact Us

Schedule Your

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Mobile appointments available

APPOINTMENT

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