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TEAM Professional Services

Thank you for choosing TEAM Professional Services to help manage your drug and alcohol testing program. Complete this form and a member of our Implementation TEAM will be in contact within 24 hours. We look forward to serving as your partner in workplace compliance.
Note: The Annual Membership Fee is $250. The first year's membership fee will be due at the end of this form.

Step 1 of 7 - Getting Started

You will need the following information to complete this form:
- Company Information
- Employee Information
  - Download .XLS Template
- Statistical Data (if you’ve completed random testing during the current year)

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Company Information
Company Name*
Phone Number*
Fax Number
Physical Address*
Note: a P.O. Box is NOT acceptable for a physical address. Please enter your P.O. Box under the next question for Mailing Address.

Street Address Address Line 2 City State ZIP Code
Is your Mailing Address different from your Physical Address?*
- Yes
- No
Mailing Address*
Street Address Address Line 2 City State ZIP Code
Industry*
Select all that apply.
North American Industrial Classification (NAICS)
If known, select one from the below list.
Services Provided By Company*
e.g., Manufacture of motor truck trailers
Hidden
FMCSA USDOT Number
If applicable, enter your organization's USDOT Number below.
Please enter a number greater than or equal to 1.
Do you contract for any Operator clients that require drug & alcohol testing?*
- Yes
- No
If yes, please specify*
Please list your company’s locations/what cities you’d like TEAM to setup testing clinics*
City State
ZIP Code

If you’d like to be setup with a specific clinic, please list the site’s information below. If nothing is listed, TEAM will setup one of our preferred collection sites in these areas.

Clinic Name	City	State

Hidden

Please list your company’s locations/what cities you’d like TEAM to setup testing clinics*

Old Field - Left in order to keep the entries.

City	State	ZIP

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Primary Contact
Full Name*
First Last Suffix
Email Address*
Note: Your email address will be your username
Phone Number*
Can this user receive background check reports?*
- Yes
- No
- N/A
Secondary Contact
Secondary Contact Full Name
First Last Suffix
Secondary Contact Email Address*
Note: Your email address will be your username
Secondary Contact Phone Number*
Can this user receive background check reports?*
- Yes
- No
- N/A
Billing Contact
Is the billing contact the same as the Primary contact?*
- Yes
- No
Billing Contact Full Name*
First Last Suffix
Billing Contact Email Address*
Note: Your email address will be your username
Billing Contact Phone Number*

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How did you hear about TEAM?*
- Ad
- Web Search
- Referral
- Conference
- Other
Please list the name of the individual/company that referred you or the other source*

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Billing Information
One-time Enrollment Fee*
Price:
Coupon Code
Total
$0.00
Credit Card

American Express
Discover
MasterCard
Visa
Supported Credit Cards: American Express, Discover, MasterCard, Visa
Card Number Expiration Date Security Code Cardholder Name
Confirmation*
- I confirm that all information provided in this form is true, complete and accurate to the best of my knowledge.
Name*
First Last
Today's Date*
Service Agreement
In order to receive background screening services from TEAM Background, LLC, the primary user for your company's account must review, accept, and sign our Service Agreement.

After you submit this form, you will receive an email from noreply@teamprofessional.com with a link to sign and submit the agreement online.

To ensure you receive this email, please add us to your address book.
Phone
This field is for validation purposes and should be left unchanged.

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First Name	Last Name	Suffix	Employee ID	Classification	Has the Employee had a Pre-Employment Drug Test	Has the employee been subject to random testing in the past 30 days?

First Name	Last Name	Phone	Email	Training Course

Accounting/Finance
Advertising/Public Relations
Aerospace/Aviation
Arts/Entertainment/Publishing
Automotive
Banking/Mortgage
Business Development
Business Opportunity
Clerical/Administrative
Construction/Facilities
Consumer Goods
Customer Service
Education/Training
Energy/Utilities
Engineering
Government/Military
Green
Healthcare
Hospitality/Travel
Human Resources
Installation/Maintenance
Insurance
Internet
Job Search Aids
Law Enforcement/Security
Legal
Management/Executive
Manufacturing/Operations
Marketing
Non-Profit/Volunteer
Pharmaceutical/Biotech
Professional Services
QA/Quality Control
Real Estate
Restaurant/Food Service
Retail
Sales
Science/Research
Skilled Labor
Technology
Telecommunications
Transportation/Logistics
Other

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TEAM Professional Services

Step 1 of 7 - Getting Started

Company Information

Primary Contact

Secondary Contact

Billing Contact

Employee Information

Services

Pricing

Billing Information

Service Agreement