Pivotal Partner Lab Application.

Please only fill out the application below to open a lab account:

Please fill out one application per location.

All sensitive data requested through this application is protected using a secure connection and military-grade encryption.

This application will require approximately 10 minutes to complete. You will need the following information:

  • Names & emails of all important contacts to be associated with this lab account.
  • Office contact & shipping information.
  • Business information, including legal name, DBA, and UPS-recognized address.
  • Financial information to be put on-file with this account.
  • A signature from an owner or authorized user of the bank account on-file.

Pivotal Partner Lab Application Form

"*" indicates required fields

Re-enter legal name from above if no DBA.
Main Contact for Lab-Related Questions*
Main Billing Contact Name*
Office Address*
EXACT Shipping Address*
Include any suite numbers, building numbers, floor numbers, etc. Any fees charged by UPS due to an incorrect or imprecise shipping address will be client's responsibility.
This address will be used for status reports, important lab notifications, etc.
Type of Lab Account*
Preferred Lab*
This is where all paperless billing correspondence such as PLN statements, invoices, etc. will be sent.
Leave blank if same as office phone.
Bank Account Type*
Must be signed by an owner or authorized user of the bank account submitted for ACH autopay on this application.