Palmetto Testing is the trusted lab screening partner for many businesses, schools, court systems, DOT-regulated organizations and corporations. Fill out the form below.

    Date: Company Name: New Reinstatement
    Main Contact Name:   Billing Contact: Same
    Mailing Address: Physical Address: Same Billing Address:Same
    City, State, Zip City, State, Zip City, State, Zip


    Who Referred You?

    # Of Employees:

    Authorized to receive drug screen results and preferred method: (Please list below or attach in a separate pdf).

    Type Of Business:
    Employee Name Employee ID#/CDL# & State
    Are you currently enrolled in a Random Drug Testing Program? Yes No
    If Yes, Consortium Name:
    Type of testing your company requires: DOT Non-Dot
    Would you like us to help with your FMCSA Clearinghouse requirements? Yes No

    Please Note: All DOT Employees Must Provide Proof Of a Negative Drug Test, or Previous Consortium Enrollment, Before They Will Be Enrolled In The Consortium Program.

    To Use A Previous Drug Test, It Must Have Been Taken Within 30 Days Prior To Joining The Consortium

    With my signature, I hereby agree to participate in Palmetto Testing consortium and further agree to abide by its rules, policies and procedures. Upon receipt of my signed application and payment, Palmetto Testing will forward me a complete membership package, which will include proof of membership and rules and regulations.

    Authorization Signature: Date: