TranSystems Corporation - LGM Construction

Drugtest.com
10750 Hammerly Blvd., Houston, TX 77043-2304 Ph: (713) 972-3472 Fax (713) 972-3449
COMMUNICATOR AUTHORIZATION AND SETUP FORM
THIS FORM MUST BE COMPLETED FOR ALL AUTHORIZED COMMUNICATORS TO BE SET UP IN OUR SYSTEM. PLEASE
MAKE A COPY FOR EACH COMMUNICATOR YOU WISH TO SET UP AND FAX EACH COMPLETED FORM BACK TO
Drugtest.com. Drugtest.com can provide sophisticated routing of communications based on content. Unless otherwise specified, all
communications are sent to the Primary communicator by default. If you would like to have additional communicators, please contact
your Drugtest.com sales representative for information on our additional communications capabilities.
Client Name:
Please circle one type of communicator:
(Primary Backup Positives Positive Backup Randoms Master Random Forms
Bulletins)
Communicator Name (first, middle initial, last) ___________________________________
Phone (______)___________ Fax (______)______________ E-Mail ___________________
Mailing Address _________ _City____________
State _____ Zip ________
Physical Address ______________________ City ___________ State ______ Zip ________
ease circle one method for receiving randoms:
(E-mail Fax Immediate Voice Response Fax On Demand Mail Overnight/Client Expense)
Please circle one method for receiving negative test results:
(E-mail Fax Mail Regular)
Drugtest.com allows you to search for nearby collection sites, submit forms, and print employee rosters over the internet.
If you would like to sign up for this service, please fill out the following User ID and Password Information:
Note: Both User ID and Password MUST BE a minimum of 6 characters long, including at least 2 numbers and 2 letters. For
example,
User ID: John25 Password: Blue32.
User ID: _______________Password: _______________
If you would like to restrict times during which Drugtest.com will attempt to send you communications,
please complete the table below.
Call After
Call Before
Mon-Thur Fri Sat Sun
Please provide the answers to these three security questions in the table below.
Questions Answers
1) What is your Social Security Number?
2) What Month were you born?
3) What numeric day were you born?