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Chandler

By Andrew Horn | June 10, 2020

1979 West Ray Rd
Chandler, AZ 85224

2075 West Warner Road
Chandler, AZ 85224

2875 W Ray Rd
Chandler, AZ 85224

3150 North Alma School Road
Chandler, AZ 85224

3705 S Arizona Ave
Chandler, AZ 85248

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DOT Consortium Program Enrollment Form

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Company Name:*
Step 1: Contact Information:
Contact Name:*
Address 1:*
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Company DOT Name:
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*
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Owner Operator:*
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Driver SSN or Employee ID:*
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* DOT pre-employment drug test must be completed before driver is added to random pool.

Step 2: Choose Enrollment Package:
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- Basic Package ($100)
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Optional Add On
*
- 2 Additional Years of Enrollment ($100)
- Part 40.25 Form ($25)
- Supervisor Training ($50/each)
- Paper Copies of 49 CFR Part 40 & 382 ($25)
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- No Additional Add-Ons = $0.00
All fees must be remitted with this form.
Add all columns on front and back on this form.
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