DOT Company Registration

If you are an Owner-Operator (FMCSA), please register here.

This program is designed for employers with employees regulated by the US Department of Transportation (FMCSA, PHMSA) as well as the US Coast Guard (USCG).

$149 one-time enrollment fee. $149 annual company dues. Pay as you go for testing: $72 per drug test. $58 per breath alcohol test.

"*" indicates required fields

1Contact Details

2Employees, DER & Additional Services

3Service Agreement

4Payment Authorization

Contact Details

Please provide accurate details. We need this information for invoicing, account set up and other correspondence.

Registration Date*

Company Name*

Main Contact Name*

First Name Last Name

Main Phone*

Direct Phone*

Email*

Fax Number

How did you hear about us?*

Other source

Name of the person who referred

DOT Agency*

If your employees are regulated by USCG, FRA or FAA, please contact us before proceeding.

DOT Number*

If you do not have a DOT number, enter "NA," or "Applied For," as appropriate.

Physical Address*

Street Address Address Line 2 City State ZIP Code

Mailing Address*

Street Address Address Line 2 City State ZIP Code

Mailing Address Same as Physical Address

Service Agreement

Service Agreement outlining the Terms and Conditions between the Client and InOut Labs.

Service Provider: InOut Labs, 456 W. Frontage Rd., Ste 103, Northfield, IL 60053

Company Name*

Responsible Individual Name*

First Name Last Name

Physical Address*

Street Address Address Line 2 City State ZIP Code

Mailing Address*

Street Address Address Line 2 City State ZIP Code

General Terms and Conditions*

I have read and agree to these General Terms and Conditions

Date*

Client Signature*

Payment Authorization

You are will be invoiced monthly for tests conducted the prior month. You may pay check, credit/debit card, or by autopay ACH via GoCardless. When you pay to join our program, we do store your card in an encrypted format and reserve the right to charge it in the event we have difficulty collecting. A 2.9% convenience fee will be added.

Billing Contact Name*

First Name Last Name

Email*

Phone*

Billing Address is Same as Physical Address

Billing Address is Same as Mailing Address

Billing Address*

Street Address Address Line 2 City State ZIP Code

Annual Random Management Fee

Price:

Annual consortium fees are per calendar year and pro-rated for the first year.

Annual Random Management Fee Q2 (Prorated based on $149/yr)

Price:

Annual consortium fees are per calendar year and pro-rated for the first year.

Annual Random Management Fee Q3 (Prorated based on $149/yr)

Price:

Annual consortium fees are per calendar year and pro-rated for the first year.

Annual Random Management Fee Q4 (Includes Q4 Plus Entire Next Year)

Price:

Annual consortium fees are per calendar year and pro-rated for the first year.

One Time Company Enrollment Fee

Price:

FMCSA Compliant Drug Testing Policy

Price:

PHMSA Compliant Drug Testing Policy

Price:

FAA Compliant Drug Testing Policy

Price:

FTA Compliant Drug Testing Policy

Price:

FMCSA Clearinghouse Support

Price:

2nd Year Payment

Price:

Would you like to pay for 2 years and discount the enrollment fee?

Yes, please

Reg ID (Optional)

Courtesy Code

One-Time Fee Enrollment Waiver

$0.00

Total

Payment Details*

Client is required to keep a payment method on file with InOut Labs. Payment information is stored in an encrypted format. Client agrees to provide updated payment method information immediately if a card expires or and account is no longer valid. Failure to pay may result in account termination.

-Credit and debit card transactions will be assessed a 2.9% processing fee.
-Your payment details are completely secure with our payment processors and our website is protected with an SSL certificate
-If you have any questions, please call us at 847-657-7900 or email us at [email protected]

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Auto-Renew*

Yes, I'd like to Auto-Renew

No. Please invoice me at renewal time

If you decide to auto-renew, your annual dues will be charged to your card on the 1st of January every year until you cancel it in writing.

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Payment Terms and Conditions*

I have read and agree to the Payment Terms and Conditions

Date*

Client Signature*

DOT Company Registration

If you are an Owner-Operator (FMCSA), please register here.

Contact Details

Employees, DER & Additional Services

Designated Employer Representative

Additional Services

FMCSA Clearinghouse Support

Service Agreement

Payment Authorization

Title