New Customer Form – TRELFA LABS, INC.

Why are you contacting us today?

Company Name *

DBA (If Applicable)

Company Address *

Address Line 1

Address Line 2

City

State

Zip Code

Website / URL

Company Type *

Main Contact Person: Full Name *

First

Last

Main 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 Name

This person will have access to test results in your Client Portal account.

Additional Person to Receive Results/Invoices (If Applicable): Email

Additional Person to Receive Results/Invoices (If Applicable): Phone

Information Additional Person Should Receive

Dairy Clients Only: Board of Health Contact Person: Full Name

Your local Board of Health inspector will have access to your test results via the Client Portal.

Dairy Clients Only: Board of Health Contact Person: Email

Dairy Clients Only: Board of Health Contact Person: Phone

Check all services of interest. *

How often do you generally submit samples?

If you need routine testing, please indicate which days.

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.

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? *

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 *