Company Drug Test/Consortium Payment
Fill out the form carefully for registration
Company/Client Name
*
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Client E-mail
*
example@example.com
Phone Number
*
Additional Comments - List Names of Employees Included in this Payment
Options - Payment is required in advance for any services
*
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Drug Test Only
USCG/DOT Compliant - 5 Panel Urinalysis
$
70.00
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Drug Test and 1 Year Consortium Membership
USCG/DOT Compliant - 5 Panel Urinalysis and 1 Year Random Drug Testing Program
$
130.00
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1 Year Consortium Membership
1 Year Random Drug Testing Program - New or Renewal
$
70.00
Quantity
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Payment Methods
Credit Card
Apple Pay
After submitting the form, you will be redirected to Apple Pay to complete the payment.
Google Pay
After submitting the form, you will be redirected to Google Pay to complete the payment.
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