DOT Owner-Operator Registration

Contact Details

Please provide accurate details. We need this information for invoicing, account set up and other correspondence.

Registration Date*

Company Name*

Main Phone*

Fax Number

Driver/Owner Name*

Email*

Mobile Phone*

How did you hear about us?*

Other Source

Name of the person who Referred

Physical Address*

Street Address Address Line 2 City State ZIP Code

Mailing Address*

Street Address Address Line 2 City State ZIP Code

Mailing Address Same as Physical Address

Driver Information for Enrollment in Consortium

Please provide accurate details. We need this information to ensure DOT compliance.

Driver Name*

Date of Birth*

Mobile Phone*

Mobile Provider*

Company DOT Number*

CDL Number*

DOT now requires that your CDL number and state of issuance be used instead of SSN.

Company Name*

State of Issuance*

Email*

Testing Location*

Local - I will do my testing close to my address

Over The Road - My testing location will vary

Other

Comments

Designated Employer Representative

The DER, or “Designated Employer Representative,” is the individual authorized to receive confidential drug test results. Enter details of a close relative or spouse to notify them of a random drug test.

DER Name*

First Last

Email*

Direct Phone*

Pre-Employment Drug Test*

I understand that membership in the InOut Labs Owner Operator Consortium is contingent upon passing a pre-employment drug test, which will be added to my cart.

Special Terms and Conditions for Owner Operators*

I have read and agree to these Special Terms and Conditions for Owner-Operators

Drug & Alcohol Testing Program Service Agreement

Service Agreement outlining the Terms and Conditions between the Client and InOut Labs.

Service Provider: InOut Labs, 456 W. Frontage Rd., Ste 103, Northfield, IL 60053

Company Name*

Driver/Owner Name*

Physical Address*

Street Address Address Line 2 City State ZIP Code

Mailing Address*

Street Address Address Line 2 City State ZIP Code

General Terms and Conditions*

I have read and agree to these General Terms and Conditions

FMCSA Clearinghouse Terms and Conditions*

Please read the Clearinghouse Terms and Conditions here.

I understand that registering for the FMCSA Clearinghouse is a federal requirement and that Owner Operators must select a C/TPA in the Clearinghouse. I agree to register and select InOut Labs as my C/TPA.

Owner-Operator Driver Consent for Annual Limited Queries

As stipulated in FMCSA rule §382.701 Drug and Alcohol Clearinghouse In lieu of a full query, an employer may obtain the individual driver's consent to conduct a limited query to satisfy the annual query requirement. The limited query will tell the employer whether there is information about the individual driver in the Clearinghouse but will not release that information to the employer. The individual driver may give consent to conduct limited queries that are effective for more than one year.

If the limited query shows that information exists in the Clearinghouse about the individual driver, the employer must conduct a full query, within24 hours of conducting the limited query. If the employer fails to conduct a full query within 24 hours, the employer must not allow the driver to continue to perform any safety-sensitive function until the employer conducts the full query and the results confirm that the driver's Clearinghouse record contains no prohibitions. The driver needs to register in the Clearinghouse and provide consent in the Clearinghouse for the full query to be fulfilled. If the driver fails to register and consent for the full query, the employer must not allow the driver to continue to perform any safety-sensitive function until the employer is able to conduct the full query and the results confirm that the driver's Clearinghouse record contains no prohibitions.

Drivers that do not intend to apply for employment with any other company in another safety-sensitive function and also have no drug or alcohol violations; do not need to register in the Clearinghouse.

By signing this Serviced Agreement, I hereby provide consent for InOut Labs to perform Limited Queries to the FMCSA Drug and Alcohol Clearinghouse for a period of five years or until my Company’s contract with C/TPA is terminated.

I also understand that InOut Labs requires a Full Query when an Owner Operator joins our program.

Date*

Client Signature*

Sign using your mouse or touch screen phone.

Automatic Payment Authorization

Schedule your payment to be automatically charged to your Visa, MasterCard, American Express or Discover Card.

Here's How Automatic Payments Work: You authorize automatic charges to your debit or credit card as services are provided by InOut Labs. A receipt for each payment will be emailed to you and the charge will appear on your credit card or bank statement. Nothing will be charged to your card until you authorize services.

Billing Contact Name*

Email*

Phone*

Billing Address Same as Physical Address

Billing Address Same as Mailing Address

Billing Address*

Street Address Address Line 2 City State ZIP Code

Owner/Operator Consortium Fee*

Price:

Consortium dues are per calendar year and pro-rated for the first year.

Owner/Operator Consortium Fee Q2 (Prorated Based on $224/yr)*

Price:

Consortium dues are per calendar year and pro-rated for the first year.

Owner/Operator Consortium Fee Q3 (Prorated Based on $224/yr)*

Price:

Consortium dues are per calendar year and pro-rated for the first year.

Owner/Operator Consortium Fee (Includes Q4 Plus Entire Next Year)*

Price:

Consortium dues are per calendar year and pro-rated for the first year.

Pre-Employment Drug Test*

Price:

Courtesy Code

Total

Payment Details*

Client is required to keep a payment method on file with InOut Labs. Payment information is stored in an encrypted format. Client agrees to provide updated payment method information immediately if a card expires or and account is no longer valid. Failure to pay may result in account termination.

-Credit and debit card transactions will be assessed a 2.9% processing fee.
-Your payment details are completely secure with our payment processors and our website is protected with an SSL certificate
-If you have any questions, please call us at 847-657-7900 or email us at [email protected]

Hidden

Auto-Renew*

Yes, I'd like to Auto-Renew.

No. Please invoice me at renewal time.

If you decide to auto-renew, your annual dues will be charged to your card on the 1st of January every year until you cancel it in writing.

Hidden

Payment Terms and Conditions*

Client is required to keep a payment method on file with InOut Labs. Payment information is stored in an encrypted format. Client agrees to provide updated payment method information immediately if a card expires or and account is no longer valid. Failure to pay may result in account termination.

I have read and agree to the Payment Terms and Conditions

Date*

Client Signature*

Sign using your mouse or touch screen phone.

DOT Owner-Operator Registration

Not an Owner Operator? Please register here.

Contact Details

Driver Information for Enrollment in Consortium

Designated Employer Representative

Drug & Alcohol Testing Program Service Agreement

Automatic Payment Authorization

Title