This is a general order form. Please fill out all the requested details. Drug Test Compliance (DTC) will contact you and review the order to ensure that you are getting the right courses. Only then will you be charged. 10% discount applies to 10 or more courses.
Fields marked with an * are required.
DFWP Supervisor$55
DFWP Employee$12.50
FMCSA Supervisor$55
FMCSA Employee$12.50
FAA Supervisor$55
FAA Employee$12.50
FTA Supervisor$55
FTA Employee$12.50
FAA Refresher$29
Supervisor Refresher$29
PHMSA Supervisor$55
PHMSA Employee$12.50
Designated Employer Representative$139
Ecstasy Short Course$5
Company Name *
Street Address *
Street Address 2 / PO Box
City *
State * —Please choose an option—ALAKASAZARCACOCTDEDCFLGAHIIDILINIAKSKYLAMEMDMAMIMNMSMOMTNENVNHNJNMNYNCNDOHOKORPARISCTNTXUTVTVAWAWVWIWY
Postal Code *
The Primary Contact should be the person who manages your training or drug/alcohol program, not a supervisor who will take the course (unless they are the same person).
First Name *
Last Name *
Contact Phone *
Contact Email *
The Billing/Ordering Contact is the person we'll contact to complete the order and to whom we will send the invoice and receipt
The Billing / Ordering Contact is the same as the Primary Contact *YesNo
First Name
Last Name
Contact Phone
Contact Email