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Myrtle Beach

By Andrew Horn | June 12, 2020

1021 Cipriana Drive
Myrtle Beach SC 29572

1203 48th Ave
Myrtle Beach SC 29577

1221 21st Ave N
Myrtle Beach SC 29577

1728 Highway 501
Myrtle Beach SC 29577

1728 Hwy. 501
Myrtle Beach SC 29577

200 Middleburg Dr
Myrtle Beach SC 29579

2761 Agnes Lane
Myrtle Beach SC 29577

909 Medical Cir
Myrtle Beach SC 29572

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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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Consortium Type: Check 1 box only, Designated Employee Representative (DER) information is required*
*
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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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- Compliance Package ($300)
  All Benefits of Basic Package plus:
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  - Required Supervisor Training
  - Part 40.25 Form (Required for all drivers)
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)
- DOT Policy ($75)
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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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