PLN – EDO Lab Application.

Please only fill out the application below if you’ve been explicitly invited by a Pivotal Group staff member to do so.

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:

Pivotal Account Number.
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 PLN account.
A signature from an owner or authorized user of the bank account on-file.

PLN Application Form – EDO

"*" indicates required fields

Pivotal Account Number for this Location*

NOTE: This will be different for every location if you have multiple offices. If you cannot remember or do not know what this is, append "I don't know".

Business Legal Name*

Business DBA Name*

Re-enter legal name from above if no DBA.

Main Contact for Lab-Related Questions*

First Last

Office Address*

Street Address Address Line 2 City State ZIP Code

EXACT Shipping Address*

Same as office address

Street Address Address Line 2 City State ZIP Code

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.

Employee-Accessible Email Address*

This address will be used for status reports, important lab notifications, etc.

Type of Lab Account*

Uncut Jobs Only

Uncut Jobs + Complete Jobs

Main Billing Contact Name*

First Last

Preferred Billing Email Address*

This is where all paperless billing correspondence such as PLN statements, invoices, etc. will be sent.

Phone Number for PLN Billing Inquiries*

Leave blank if same as office phone.

Section Break

Bank Name

Bank Account Number*

Bank Routing Number*

Bank Account Type*

Checking

Savings

Electronic Signature*

Must be signed by an owner or authorized user of the bank account submitted for ACH autopay on this application.