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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
{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
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