M2Z COMPLIANCE SOLUTIONS
CONSORTIUM ENROLLMENT & RTD MANAGEMENT PROGRAM CONSOLIDATED CONSENT & ENROLLMENT FORM
REGISTERED C/TPA | FMCSA
HIPAA-COMPLIANT | ALL 50 STATES
Complete this form to enroll in any combination of M2Z programs. Select all that apply and fill in only the sections relevant to you.
(888) 282-2279 | info@m2zcompliance.com | m2zcompliancesolutions.com | Sugar Hill, GA 30518
Instructions:
This is one consolidated form covering all M2Z enrollment programs. In Section A, check every program you are enrolling in. Then complete only the sections that apply to your selection. All fields marked * are required.
* = Required field
SECTION A — SELECT YOUR PROGRAM(S) (Check all that apply)
Select every program or service you are enrolling in today. Complete only the sections below that match your selections.
OWNER-OPERATOR PROGRAMS
RTD O/O Consortium Enrollment - $99/year
Owner-Operator Consortium Enrollment — $129/year
FLEET & EMPLOYER PROGRAMS
Small Fleet Consortium (2-5 Drivers) - $199/year
Small Fleet Consortium (6-10 Drivers) - $299/year
Small Fleet Consortium (11-15 Drivers) - $399/year
Small Fleet Consortium (16-20 Drivers) - $599/year
ADD-ON PROGRAMS
Employer RTD Case Management - $175/driver (member) I $225/driver (non-member)
Driver Retention & RTD Repayment Program - included with RTD Case Management
Follow-Up Compliance Program - $49/month per driver
DQ File Management - see fleet rate schedule
Driver Compliance Binders - $25-$35 per binder
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SECTION B — YOUR CONTACT INFORMATION
Full Legal Name / Business Name
*
First Name
Last Name
Individuals only
Date of Birth (MM/DD/YYYY)
-
Month
-
Day
Year
Date
Mobile Phone Number
*
Format: (000) 000-0000.
Email Address
*
example@example.com
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Company / Organization Name
If applicable — employers complete this
Title / Role
e.g. Owner, Fleet Manager, Safety Director
SECTION C — CDL & DOT INFORMATION (All O/O programs required | Employers: complete DOT # and Clearinghouse fields
CDL Number
Owner-operators required
State CDL is Registered In
CDL Expiration Date
-
Month
-
Day
Year
Date
MM/DD/YYYY
Active FMCSA DOT Number
Required for all O/O and fleet enrollment
FMCSA Clearinghouse Login Email
example@example.com
Clearinghouse Driver ID
Optional
SECTION D— RTD O/O CONSORTIUM (Complete only if selected in Section A — $99/year)
This section is for owner-operators who completed the Return-to-Duty (RTD) process with M2Z Compliance Solutions. Your Clearinghouse must currently show Not Prohibited before enrollment can be activated.
I completed my RTD process with M2Z Compliance Solutions
My FMCSA Clearinghouse status shows Not Prohibited
RTD Completion Date (approx.)
-
Month
-
Day
Year
Date
MM/DD/YYYY
M2Z Case Number (if known)
Optional — speeds up enrollment
Follow-Up Testing Plan:
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Enroll me in the M2Z Follow-Up Compliance Program - $49/month
I will manage follow-up testing independently
SECTION E— OWNER-OPERATOR CONSORTIUM (Complete only if selected in Section A — $129/year)
This section is for owner-operators enrolling directly in the M2Z DOT random testing consortium without a prior RTD case with M2Z. A negative pre-employment DOT drug test is required by federal law before you can be added to the active random testing pool.
Pre-Employment Drug Test Status:
I have completed a negative pre-employment DOT drug test
Pre-Employment Test Date
-
Month
-
Day
Year
Date
Testing Provider / Location
I need M2Z to order my pre-employment DOT drug test - $85 (billed separately)
SECTION F—FLEET & EMPLOYER CONSORTIUM (Complete only if a fleet program was selected in Section A)
The annual fee covers ALL enrolled drivers in your fleet bracket. One flat annual payment. Tests are billed separately at member rates when a driver is randomly selected.
List your CDL drivers below. Attach additional sheet if you have more than 6 drivers.
Rows
Driver Full Name
CDL Number
CDL State
CDL Exp. Date
Pre-Emp Test Done?
1
2
3
4
5
6
7
8
9
10
11
12
Note: A negative pre-employment DOT drug test ($85) is required for each driver before they can be added to the active random testing pool. M2Z can coordinate all pre-employment testing.
SECTION G— EMPLOYER RTD CASE MANAGEMENT (Complete only if selected in Section A)
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M2Z manages the entire RTD case on your behalf - SAP coordination, test scheduling, Clearinghouse reporting, and follow-up management. Total employer advance per driver: $474 (M2Z Case Management $175 + RTD Complete Package $299). Driver repays employer via payroll deduction using the M2Z Driver RTD Agreement.
Driver Name (Violation)
Driver's CDL Number
Violation Type (Drug / Alcohol / Refusal)
Date of Violation
-
Month
-
Day
Year
Date
Has driver started SAP process? (Yes / No / Unknown)
SAP Name (if known)
Select driver repayment option:
Option A - Company-Assisted RTD
Employer pays M2Z $474 upfront. Driver repays via payroll deduction over 2-3 months.
Option B - Self-Funded RTD
Position held 90 days. Driver covers own costs and presents green checkmark to return.
SECTION H— ACKNOWLEDGMENTS & CONSENT
C/TPA Authorization: I/We authorize M2Z Compliance Solutions to act as Consortium/Third-Party Administrator (C/TPA) in the FMCSA Drug and Alcohol Clearinghouse for the programs selected above. M2Z will manage random testing pools, conduct Clearinghouse queries, notify when selected for testing, report violations, and manage RTD cases as applicable. I/We understand the employer retains ultimate responsibility for compliance under 49 CFR Part 382. I/We authorize M2Z to contact the SAP(s) listed above directly on my/our behalf.
*
I/We authorize M2Z Compliance Solutions to act as our C/TPA in the FMCSA Clearinghouse
Required - enrollment cannot proceed without this authorization
I/We understand random tests are unannounced and drivers must report immediately when notified
Failure to report is treated as a refusal under DOT regulations - same consequence as a positive test
I/We understand random testing rates are 50% for drugs and 10% for alcohol annually (2025 rates)
M2Z manages all selections to meet FMCSA required rates throughout the year
I/We understand all annual enrollment fees are non-refundable once enrollment is processed
All sales are final per the M2Z Refund Policy
I/We understand RTD case management fees ($175/$225) are non-refundable once the case is opened
Services begin immediately upon case opening including SAP contact and Clearinghouse coordination
I/We understand the Follow-Up Compliance Program ($49/month) is the driver's direct responsibility
Driver pays M2Z directly. Employer is not responsible for monthly follow-up program fees.
I/We have read and agree to the M2Z Terms & Conditions, Privacy Policy, and Refund Policy
Full policies available at m2zcompliancesolutions.com - copies available upon request
I/We acknowledge that submitting this form authorizes M2Z to begin enrollment immediately
Services commence upon receipt of this form and confirmation of payment
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SECTION I-PAYMENT
Select your payment option and complete your payment information below. Your total will be confirmed by M2Z before processing.
PAYMENT OPTION
Pay in Full Single payment for all selected programs. Amount confirmed at checkout.
Split Pay - RTD Package Only ($150 now / $149 before Clearinghouse update) Applies to RTD Complete Package only. Balance due before test is scheduled.
Buy Now Pay Later - Afterpay/Sezzle / Klarna (4 installments) Available for RTD package and consortium enrollment. Subject to BNPL provider approval.
PAYMENT METHOD
Credit / Debit Card Processed securely below
Afterpay / Sezzle / Klarna Link sent to your email after form submission
Credit / Debit Card Information:
Name on Card
Expiration Date
-
Month
-
Day
Year
Date Picker Icon
Billing Zip Code
Your payment information is processed securely. M2Z does not store card numbers. All transactions are encrypted. Charges appear as M2Z COMPLIANCE on your statement. All sales are final.
PAYMENT SUMMARY
Rows
Amount
e.g. RTD O/O Consortium
e.g. Owner-Operator Consortium
e.g. Small Fleet Consortium
e.g. Employer RTD Case Management
SECTION J- ELECTRONIC SIGNATURE
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By signing below I confirm that all information provided is accurate, I have read and agreed to all acknowledgments in Section H, and I authorize M2Z Compliance Solutions to begin enrollment in the programs selected in Section A.
Typed Full Name (Electronic Signature)
*
Date
*
-
Month
-
Day
Year
Date
Title (if signing on behalf of a company)
Company Name (if applicable)
FOR OFFICE USE ONLY
Received By
Date Received
-
Month
-
Day
Year
Date
Account / Enrollment #
Renewal Date
-
Month
-
Day
Year
Date
Programs Enrolled
Payment Confirmed
Clearinghouse Set Up
Welcome Email Sent
Internal Notes
M2Z Compliance Solutions | HIPAA-Compliant | Registered C/TPA | All Sales Final | Form M2Z-MASTER-001 | © 2026
(888) 282-2279 | info@m2zcompliance.com | m2zcompliancesolutions.com
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