CLEARINGHOUSE Company Registration Form
Per Federal Regulation 49 CFR Part 382, all employers and owner-operators are mandated to register any CDL drivers they employ with the FMCSA Drug and Alcohol Clearinghouse.
BUSINESS INFORMATION
Legal Business Name
*
Doing Business As Name
If different from Legal Business Name
USDOT Number
*
FMCSA PIN
Email
*
Phone Number
*
Company Owner Name
*
First Name
Last Name
Select your role:
*
Owner-Operator
Employer
Do you have FMCSA Portal account?
*
Yes
NO
FMCSA account Username:
FMCSA account Password:
Physical Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Mailing Address
*
Same as Physical Address
Mailing Address is Different
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
DRIVER INFORMATION
Total Number of CDL Drivers
*
Driver details
*
Provide Drug & Alcohol Random Testing Program you are enrolled in name:
*
SIGNATURE
Terms and Conditions
*
TYPE YOUR NAME
*
Signature
*
Date
-
Month
-
Day
Year
PAYMENT INFORMATION
*
prev
next
( X )
CLEARINGHOUSE REGISTRATION
$
141.00
Total number of CDL drivers
0
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
Item subtotal:
$
0.00
Credit Card Details
First Name
Last Name
Credit Card Number
Security Code
Card Expiration
Additional Comments
Submit
Should be Empty: