Account Name * Tax ID Number * Bill to Address * Ship to Address Your Full Name * Your Email * Your Phone * Accounts Payable Contact * Accounts Payable Contact Email * Accounts Payable Contact Phone * Purchasing Contact Purchasing Contact Email Purchasing Contact Phone DEA Number with Expiration Date * Is Your Business Tax Exempt? * YesNo Sales Person Name (at My Lab Partners) Credit Reference 1 Please enter reference name, account number, email and phone for reference. Credit Reference 2 Please enter reference name, account number, email and phone for reference. How Would You Prefer to Pay Your Bills? * ACH Draft at time of ShipmentACH Draft on the 29th of the MonthCheck made payable to My Lab Partners with terms of NET30 (subject to approval by Management)Credit Card Autopay at time of Shipment
