Please provide the information requested below. The information you provide shall remain strictly confidential and
shall not be leased or sold or be used for any other purpose other than the intended use of your submission.
Contact Info
Digital Signature
I agree all information is correct
The undersigned confirms that the above information is true and accurate and hereby authorizes Lab Alley, LLC to obtain
credit and/or financial information from the bank and references listed above If given open terms of credit with Lab Alley,
LLC., the undersigned promises to pay for all purchases in accordance with those terms. The undersigned guarantees
payment of all invoices. If at any time the undersigned is unable to meet its financial obligations with Lab Alley LLC. the
undersigned agrees to pay for legal, court and any other fees necessary to collect unpaid invoices. The undersigned also
consents to receive faxes, emails and mailings on behalf of Lab Alley, LLC.
.