PLN Lab Application

Please only fill out the application for a lab account with one of our lab partners.

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 Group main account email and 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 Forms

"*" indicates required fields

NOTE: This will be different for every location if you have multiple offices. You can leave this blank if you cannot remember or do not know what this is.
Re-enter legal name from above if no DBA.
Main Contact for Lab-Related Questions*
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*
Are you interested in "Consolidated Shipping" to keep shipping costs down?*
Main Billing Contact Name*
This is where all paperless billing correspondence such as PLN statements, invoices, etc. will be sent.
Leave blank if same as office phone.

Section Break

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