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773-245-7180

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Mobile Request

We come to you and perform a one-time test

Designated Employer Representative

Company Name

DER or Person in Charge

Phone Number

Email Address

Mobile Request Location

Address

City

State

Zip Code

Name of person being tested?

Phone Number

Name of location where they are

Truck or car color

Make

Male or Female

Additional information we should know

Date Requesting Service

What date are you requesting Mobile Testing services?

People Being Tested

How many people will be receiving tests?

What tests do you want performed?

Post Accident - Alcohol

Post Accident - Urine

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DOT Urine Test

DOT Alcohol Test

NON DOT Urine

NON DOT Alcohol

Hair Drug Test

ETG Urine Test

Your First Name

Your Last Name

Your Phone Number

Your Email

Your Position

Billing Information

Billing Contact First Name

Billing Contact Last Name

Billing Contact Phone

Billing Contact Email

Billing Contact Fax

Locations

Georgia - Corporate Office

3280 Pointe Parkway., Ste 2000

Peachtree Corners, GA 30092

Phone: 404-300-3700

Fax: 404-300-3614

Illinois - Branch Location

3317 W. 95th St. Ste 7

Evergreen Park, IL 60805

Phone: 773-245-7180

Fax: 773-455-4085

Order a DOT Urine Test

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