Customer Information Form | TRELFA LABS, INC.

Why are you contacting us today? *

I'm a new customer.
I'm a current customer, updating my contact information.

Company Name *

Parent company / company responsible for payment.

DBA Company Name (If Applicable)

Doing Business As / alternate business name.

Billing Address *

Address Line 1

Address Line 2

City

State

Zip Code

Manufacturing or Retail Address (If Different from Billing)

Address Line 1

Address Line 2

City

State

Zip Code

Website URL

Company Type *

Briefly describe your product line(s):

Main Contact Person: Full Name *

First

Last

Main Contact Person: Title/Position *

Main Contact Person: Email *

Main Contact Person: Phone *

Accounts Payable Person: Full Name *

This person will have access to test results in your Client Portal account unless you instruct us to remove them.

Accounts Payable Person: Title/Position *

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. Please note that invoices can only be sent to two email accounts in your company file.

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

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

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

Information Additional Person Should Receive

Test Results, Completed Projects
Invoices

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.

How do you typically deliver samples?

Carrier
Drop Off
Lab Pick Up

If you have your own fleet, please note that there is plenty of parking to accomodate large delivery trucks.

Check all routine on-site sampling needs, if applicable.

Who will collect on-site samples?

Trelfa Labs' Technician
Your Company Employee

Briefly describe your on-site sampling needs including routine schedule, if applicable.

Exampe: 20 swabs/month, 10 air plates/quarter

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.

Preferred Payment Method *

Pay from invoice (using credit card or ACH/e-check)
Pay via bank transfer (using ACH)
Authorize Trelfa Labs to automatically make payments on your behalf (as needed)
Mail check or US money order
Pay via phone (using credit card or ACH/check)

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 *