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Please fill out the information to the best of your knowledge. The Personal Experience Field for is to be marked 'YES', if indeed, you have personal experience any type of drug testing with this company. The comments field is reserved for any additional comments that you will to make concerning this company. This would be a good place to indicate and experience with this company concerning their drug testing practices. As always, we do not record any personal information concerning this submittal.

Name of Company  
Address (If Known)
Company City  
Company State
Business Type  
Drug Test Used  
Frequency of Test  
Personal Experience  
Testing characteristics
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