The Compliance Resource Group

Complete the form below to enroll your company in the DOT Program Administration Service (PAS)

Need to enroll more than 15 DOT covered employees? You may qualify for discounted enrollment fees. CLICK HERE to find out.

Will you be enrolling more than 15 employees in the DOT Program?
YES, I HAVE MORE THAN 15
If you're enrolling less than 15 employees, please continue to the form below!
Company Name*
Mailing Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Contact Person*
Contact Email
Phone*
Secure Fax
DOT # (if applicable)
Secondary Contact
Please select a reporting method for Negative test results*
Secure Fax
Secure Email
Select the # of employees to be enrolled in the DOT Program*
Employee 1
Price:
Employee 1
Price:
DOT agency*
Name*
First Last
CDL #*
State of Issuance*
Date of Birth*
Month
Day
Year
SSN*
Please do not separate the number with any dividing characters such as dashes (-) or periods (.)
Employee 2
Price:
DOT agency
Name
First Last
CDL #
State of Issuance
Date of Birth
Month
Day
Year
SSN
Please do not separate the number with any dividing characters such as dashes (-) or periods (.)
Employee 3
Price:
DOT agency
Name
First Last
CDL #
State of Issuance
Date of Birth
Month
Day
Year
SSN
Please do not separate the number with any dividing characters such as dashes (-) or periods (.)
Employee 4
Price:
DOT agency
Name
First Last
CDL #
State of Issuance
Date of Birth
Month
Day
Year
SSN
Please do not separate the number with any dividing characters such as dashes (-) or periods (.)
Employee 5
Price:
DOT agency
Name
First Last
CDL #
State of Issuance
Date of Birth
Month
Day
Year
SSN
Please do not separate the number with any dividing characters such as dashes (-) or periods (.)
Employee 6
Price:
DOT agency
Name
First Last
CDL #
State of Issuance
Date of Birth
Month
Day
Year
SSN
Please do not separate the number with any dividing characters such as dashes (-) or periods (.)
Employee 7
Price:
DOT agency
Name
First Last
CDL #
State of Issuance
Date of Birth
Month
Day
Year
SSN
Please do not separate the number with any dividing characters such as dashes (-) or periods (.)
Employee 8
Price:
DOT agency
Name
First Last
CDL #
State of Issuance
Date of Birth
Month
Day
Year
SSN
Please do not separate the number with any dividing characters such as dashes (-) or periods (.)
Employee 9
Price:
DOT agency
Name
First Last
CDL #
State of Issuance
Date of Birth
Month
Day
Year
SSN
Please do not separate the number with any dividing characters such as dashes (-) or periods (.)
Employee 10
Price:
DOT agency
Name
First Last
CDL #
State of Issuance
Date of Birth
Month
Day
Year
SSN
Please do not separate the number with any dividing characters such as dashes (-) or periods (.)
Employee 11
Price:
DOT agency
Name
First Last
CDL #
State of Issuance
Date of Birth
Month
Day
Year
SSN
Please do not separate the number with any dividing characters such as dashes (-) or periods (.)
Employee 12
Price:
DOT agency
Name
First Last
CDL #
State of Issuance
Date of Birth
Month
Day
Year
SSN
Please do not separate the number with any dividing characters such as dashes (-) or periods (.)
Employee 13
Price:
DOT agency
Name
First Last
CDL #
State of Issuance
Date of Birth
Month
Day
Year
SSN
Please do not separate the number with any dividing characters such as dashes (-) or periods (.)
Employee 14
Price:
DOT agency
Name
First Last
CDL #
State of Issuance
Date of Birth
Month
Day
Year
SSN
Please do not separate the number with any dividing characters such as dashes (-) or periods (.)
Employee 15
Price:
DOT agency
Name
First Last
CDL #
State of Issuance
Date of Birth
Month
Day
Year
SSN
Please do not separate the number with any dividing characters such as dashes (-) or periods (.)
Total
$0.00
Credit Card*

American Express
Discover
MasterCard
Visa
Supported Credit Cards: American Express, Discover, MasterCard, Visa
Card Number Expiration Date Security Code Cardholder Name
Confirm Card Number*
Confirm Card Number
Confirm Expiration Date*

Confirm Expiration Date
Billing Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Billing Email*
Enter Email Confirm Email
Hidden
This agreement is made as of
MM slash DD slash YYYY
Terms and Conditions

The Initial Term of this Agreement shall be one (1) year, beginning from the date entered herein. Thereafter, this Agreement will renew at the end of the initial term and will continue in effect on an extended term basis. Either party may cancel this Agreement on thirty (30)-days written notice to the other party by certified mail, return receipt requested, or personal delivery with a signed receipt from the other party.

SERVICES
CRG is a “Third Party Administrator” (TPA) for substance abuse testing programs and on behalf of the client and when notified to do so by the client or the client’s designee, will provide drug and alcohol testing services for clients of the named client.

PAYMENT
Client acknowledges and authorizes payment for all services, including but not limited to: enrollment fees, shipping fees, drug testing fees, alcohol testing fees, and physical exam fees, to be made using the credit card provided. In the event that the credit card payment is declined, client will be subject to a re-processing fee of $25.00. All past due payments may be subject to an additional interest and service charge calculated at the rate of one and one-half percent (1.5%) per month from the date the invoice becomes past due until the payment is received by CRG. If it should become necessary to turn this account to a third party for collection, the client is liable for the cost of such collection, including any legal costs.

PERSONAL GUARANTEE
In the event the Client seeks protection from creditors as a result of dissolution, bankruptcy, or any other means, the company representative below agrees to personally assume any outstanding debt owed to CRG, and by signing this agreement acknowledges a personal guarantee of payment for all services rendered by CRG to Client.

CONFIDENTIALITY
CRG understands the confidential nature of substance abuse testing and agrees to take reasonable steps to ensure that information concerning tests shall be communicated only to the persons listed in this agreement without written authorization from client.

UNAVOIDABLE EVENTS
In no event shall CRG have any liability to the client for any failure or delay in performance which results from or is due to, directly or indirectly and in whole or in part, any causes or circumstances beyond the reasonable control of CRG.

GOVERNING LAW
This Agreement has been executed and delivered in, and shall be construed and enforced in accordance with the laws of the State of Oklahoma. This Agreement may be amended only by any instrument in writing signed by all parties.

PRICES
DOT Program Administration Service Annual Enrollment
$60.00 / covered employee ($100.00 minimum)
DOT Urine Drug Screen
$50.00 each
DOT Breath Alcohol Test
$30.00 each
FMCSA Driver Medical Certification (DOT Physical)
$65.00 each
Non-Compliance Fee (failure to perform required random testing)
$25.00 / incomplete test

*Additional fees will apply for services not performed at CRG Laboratories in Oklahoma City, OK.

PRIVACY POLICY
We respect and are committed to protecting your privacy. We may collect personally identifiable information when you visit our site. We also automatically receive and record information on our server logs from your browser including your IP address, cookie information and the page(s) you visited. We will not sell your personally identifiable information to anyone.

SECURITY POLICY
Your payment and personal information is always safe. Our Secure Sockets Layer (SSL) software is the industry standard and among the best software available today for secure commerce transactions. It encrypts all of your personal information, including credit card number, name, and address, so that it cannot be read over the internet.

REFUND POLICY
All refunds will be provided as a credit to the credit card used at the time of purchase within thirty (30) business days upon written cancellation of agreement.

ENTIRE AGREEMENT
This Agreement supersedes all previous agreements between these parties and constitutes the entire agreement between the parties concerning the subject matter herein.

IN WITNESS WHEREOF, the parties hereto have executed this agreement as of the date above.

I acknowledge that by clicking submit I agree to the terms outlined in this agreement and am authorizing payment for enrollment in the DOT Drug and Alcohol Testing Consortium administered by The Compliance Resource Group using the credit card provided. I understand that enrollment is not complete until payment of the enrollment fee has been received by The Compliance Resource Group, Inc. I understand that I am enrolling in a program designated only for employees falling under DOT regulations and that no information has been provided for employees not falling under DOT regulations. I acknowledge that to the best of my knowledge all information provided is accurate and up to date.
By clicking submit I agree to the terms and conditions
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Complete the form below to enroll your company in the DOT Program Administration Service (PAS)

Terms and Conditions