The drug and alcohol testing program guaranteed to meet all of the Coast Guard's requirements

© 2015 Maritime Consortium, Inc.
409 Chester Ave, Suite 102
PO Box 4070
Annapolis, MD 21403-6070
Ph. 800.775.6985
Email Us

 

The Maritime Consortium

Ship Store

for members only



Directions: You can fill this form out on line in your browser and submit it on our secure server, or print it and mail. If submitting online you will get a confirmation via email within 10 minutes.
Download this Form in PDF Format

Company:
Account number
Contact:
email
Address:
Telephone
City:
State:
Zip:
Description (regular USPS Mail shipping included)
Number
Cost
Amount
M-PAK
(for each employee) includes:
1)
A drugtesting chain of custody form,
2) A regulatory-approved alcohol kit,
3) Post Accident Instructions and forms
$15.00
Additional Drug Program Handbooks with regulations
(company policy and all required USCG steps for compliance)
$10.00
Employee Assistance Program on CD (60 min)
$7.50
Additional 6x9 inch, three color, waterproof vessel stickers
$7.00
Complete Copy of US DOT & USCG Regulations
(available on-line at www.drugfreevessel.com, click on Members Area)
$39.00
Overnight Shipment
Mon - Fri: $25, Sat: $35,please provide street address below) NOTE: Order Form, Payment & Address Information MUST BE received By 3PM EST
select one above
$25.00
Mon-Fri

$35.00
Sat-Delv

TOTAL
Payment: VISA MCAMEX
Credit Card Number
C V V
Expires
Cardholder Name
Please Provide a street address for overnight shipping(deliveries cannot be made to post office boxes)*.

OR FAX OR MAIL TO OUR ADDRESS BELOW:


 

 

The Maritime Consortium, Inc. • PO BOX 4070 • Annapolis, MD 21403 • (800) 775-6985