Client Information Request

CellEx Consulting Group

cellexconnect.com

(224) 404-6114
info@yourcdlguard.com

New Client Intake

Provide CellEx with the information needed to set up your compliance program.

Company Information

Company / Carrier Name *

DBA (if different)

USDOT #

MC #

Address

City, State, ZIP

Contact Information

Contact Name *

Title / Position

Email *

Phone *

Operations Overview

Type of Operation

Freight / Commodity Type

Number of Power Units

Number of CDL Drivers

Primary Operating States

Current Safety Rating

Services Needed

DCAP (Full Compliance) Drug & Alcohol TPA DQ File Management ELD Monitoring Audit Prep / Defense Driver Training

Reason for Contacting CellEx

Credit Card Authorization

By completing this section you authorize CellEx Consulting Group, Inc. to charge the credit card provided. The exact fee will be confirmed before your card is charged.

Cardholder Name *

Card Type

Card Number *

Expiry *

CVV *

I authorize CellEx Consulting Group, Inc. to charge the credit card above for services requested. I confirm I am authorized to use this card.

Disclaimer & Limitation of Liability

CellEx Consulting Group, Inc. acts solely as a compliance consultant and facilitator. We do not provide legal advice, and nothing provided through our services constitutes legal counsel. We strongly recommend consulting a licensed attorney before executing any agreement, contract, or business transaction.

1. SCOPE OF SERVICES. CellEx Consulting Group provides regulatory compliance consulting, document preparation, filing assistance, and administrative support for transportation companies. Our services are advisory in nature. Final responsibility for regulatory compliance rests with the carrier and its principals.

2. NO LEGAL ADVICE. Nothing communicated by CellEx constitutes legal advice. CellEx consultants are not attorneys and cannot represent you in legal proceedings.

3. NO GUARANTEE OF OUTCOMES. CellEx makes no representation or warranty that services will result in any particular regulatory outcome, approval, or decision by any government agency.

4. ACCURACY OF INFORMATION. The client is solely responsible for the accuracy and completeness of all information provided to CellEx.

5. LIMITATION OF LIABILITY. TO THE FULLEST EXTENT PERMITTED BY LAW, CELLEX SHALL NOT BE LIABLE FOR ANY DIRECT, INDIRECT, INCIDENTAL, CONSEQUENTIAL, OR SPECIAL DAMAGES ARISING FROM ITS SERVICES.

6. GOVERNING LAW. This engagement shall be governed by the laws of the State of Illinois. Disputes shall be resolved in Cook County, Illinois courts.

I have read and understand the CellEx Consulting Group Disclaimer and Limitation of Liability. I acknowledge CellEx provides compliance consulting only and does not provide legal advice.

Authorized Signature

By signing below, you confirm all information is accurate and you are authorized to request and pay for these services on behalf of your company.

Signature *

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Printed Full Name *

Date

✅ Submitted! CellEx will contact you within 1 business day.
📞 (224) 404-6114 · ✉️ info@yourcdlguard.com