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West Columbia

By Andrew Horn | June 12, 2020

2 Southern Ct
West Columbia SC 29169

2249 Augusta Road
West Columbia SC 29169

2836 Augusta Rd
West Columbia SC 29170

3020 Sunset Blvd
West Columbia SC 29169

3020 Sunset Boulevard
West Columbia SC 29169

634 Sunset Boulevard
West Columbia SC 29169

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DOT Consortium Program Enrollment Form

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Company Name:*
Step 1: Contact Information:
Contact Name:*
Address 1:*
Address 2:
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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)
  - 1-Year Enrollment in Randoms
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  - Paper CCFs or Electronic CCFs
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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)
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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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