For Members Only

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Company*

Contact Person*

Account Number*

Email*

Phone*

Street Address*

Address Line 2

City*

State*

Zip Code*

Store Fees

M-PAKs

$20 per kit (covers one captain/crewmember) (Mailed out within 2-3 weeks unless FEDEX is requested) See here for regulation

Price:

Quantity

Additional Drug Program Handbooks with regulations

(company policy and all required USCG steps for compliance)

Price:

Quantity

Drug Program Handbooks with regulations – Digital

(company policy and all required USCG steps for compliance)

Price:

Quantity

Employee Assistance Program on Flash Drive

(60 min)

Price:

Quantity

Employee Assistance Program – Digital

(60 min)

Price:

Quantity

Additional 6×9 inch, three color, waterproof vessel stickers

Price:

Quantity

Complete Copy of US DOT & USCG Regulations

(available on-line at www.drugfreevessel.com, click on Members Area)

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Quantity

Shipping Method*

(Please specify Priority or Overnight shipping)

Priority USPS Mail

Fed Ex Overnight Mon-Fri

Fed Ex Sat Delivery

Payment Information

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Cardholder Name

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Expires

CCV

Please Provide a street address for overnight shipping

(deliveries cannot be made to post office boxes)