Completion of this form verifies that you agree to Trelfa Labs’ Terms and Conditions. Why are you contacting us today?I'm a new customer.I'm a current customer, updating my contact information.Company Name *DBA (If Applicable)Company Address *Address Line 1Address Line 2CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeWebsite / URLCompany Type *CommissaryContract SanitationDairyFood DistributorFood RetailerFood Service OperatorFood/Beverage Manufacturer (sm)Food/Beverage Manufacturer (lg)Food/Beverage PackagingLaboratory (contract work)Pharmaceutical Manufacturer (sm)Pharmaceutical Manufacturer (lg)Raw Materials SupplierRestaurant / RetailStart Up IncubatorOtherMain Contact Person: Full Name *FirstLastMain Contact Person: Title *Main Contact Person: Email *Main Contact Person: Phone *Accounts Payable Person: Full Name *Accounts Payable Person: Email *Accounts Payable Person: Phone *Additional Person to Receive Results/Invoices (If Applicable): Full NameThis person will have access to test results in your Client Portal account.Additional Person to Receive Results/Invoices (If Applicable): EmailAdditional Person to Receive Results/Invoices (If Applicable): PhoneInformation Additional Person Should ReceiveTest Results, Completed ProjectsInvoicesDairy Clients Only: Board of Health Contact Person: Full NameYour local Board of Health inspector will have access to your test results via the Client Portal.Dairy Clients Only: Board of Health Contact Person: EmailDairy Clients Only: Board of Health Contact Person: PhoneCheck all services of interest. *Analytical TestingFacility PlanningFood Safety AuditsFood Safety ConsultingFood Safety LiaisonFood Safety TrainingMethod ValidationNutrition Panels/LabelingShelf Life StudiesHow often do you generally submit samples?DailyWeeklyMonthlyAs NeededIf you need routine testing, please indicate which days.MondayTuesdayWednesdayThursdayFridayYou must notify the lab of any changes in your sampling schedule. Failure to provide samples for scheduled pickups are subject to a $30 minimum fee.Dairy Clients Only: Please indicate the months you require testing for your season. Examples: May - October, Year Round, etc.You must notify the lab of any changes in your sampling schedule. Failure to provide samples for scheduled pickups are subject to a $30 minimum fee.Please indicate visitor/parking instructions for your facility, if applicable.Would you like to authorize Trelfa Labs, Inc. to process your credit card for payments on your behalf? *Yes. We will forward the authorization form.No. We will submit our own payments.Please let us know how you found us, whether by referral, web site search, or other means. *Please list any additional comments, recommendations, or requirements below.Date / Time *WebsiteSubmit