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Ver 012023.0 ADDENDUM Drug Testing/Occupational Healthcare Services |
End-User is aware that additional fees may be applicable under the following circumstances:
1. End-User utilizes Emergency Post Accident/After Hours Drug and Alcohol Testing Services
2. End-User requests overnight delivery of Reports or Drug Testing Materials
3. End-User requires Litigation Support Materials or Expert Witness Testimony
I certify that I am authorized to execute this Addendum on behalf of the Company listed below. Further, I certify on behalf of End-User Company that the above statements are true and correct and agree to the terms and conditions set forth.
| {COMPANYNAME} __________________________________________ Company or Business Legal Name |
Applicant Insight, Inc. |
|
| {COMPANYADDRESS} __________________________________________ Address (Street, City, State, Zip Code) |
7324 Little Road, New Port Richey, FL 34654 |
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| {COMPANYPHONE} __________________________________________ Telephone Number/Fax Number |
Phone: 800-771-7703/Fax: 800-890-6454 |
|
__________________________________________ Signature of End-User’s Authorized Agent |
__________________________________________ Signature on Behalf of Applicant Insight |
|
| {COMPANYPRINTEDNAME} __________________________________________ Printed Name |
__________________________________________ Printed Name |
|
| {COMPANYTITLE} __________________________________________ Title |
__________________________________________ Title |
|
| {COMPANYDATE} __________________________________________ Date |
__________________________________________ Date |