LIMS Registration

Institution/Company Name*
National Provider Identifier
Type of Facility (chose best answer)
- Academic Institution
- Reference Laboratory
- Pharma / Biotech / CRO
- Veterinary / Production Animal
Primary Contact*
Your Email*
Your Telephone #*
Billing Contact*
Business Email*
Billing Telephone #*
Certifications (if applicable)
FEIN Number
Lab Permit Number (e.g. CLIA)
VAT Tax Number
Tax Exemption Certificate (pdf only)
Drop files here or

Accepted file types: pdf.
Name
This field is for validation purposes and should be left unchanged.

Certifications (if applicable)