LWD Inc. Enrollment

About LWD

Services

Testing Kits

Owner Operators

Consortium

Enrollment

To enroll in an LWD, D.O.T. Approved Consortium, please follow the instructions below.

If you are an Owner Operator:		If you are an Employer:
1. 2. 3. 4. 5.	Fill out online form and submit Complete Owner/Operator Agreement Complete Release of Information Complete payment sheet Fax to (626) 813-1088.	1. 2. 3. 4. 5.	Fill out online form and submit Complete Employer Agreement Complete Random Driver list Complete payment sheet Fax to (626) 813-1088.

Online Form

Company Name:

Contact:

Address:

City:

State:

Zip:

Phone Number:

Email Address:

Consortium type you wish to join:

Owner Operator

Independent Employer

Employer

Don't know

# of Drivers:

(Enter 1 if Owner Operator)

Special Instructions:

Upon clicking the Enroll Now button AND faxing the appropriate forms above, an LWD representative will contact you the same day or the following business day to confirm your enrollment and to obtain payment.

Once payment is received, an official Certificate of Enrollment and a Consortium Member Packet will be mailed to you. A Certificate of Enrollment may be faxed to you upon request.


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