LTM Customer Information Form

Customer Information

Customer account setup may take up to five (5) business days. If you plan to submit samples sooner, please note in Comments (below).

Organization Address
Samples will be submitted for
Billing Information
Billing Address

The primary will be set up as the main contact for account/user authorization and will receive the results for all orders associated with the account. (Additional contacts can be listed and will also receive results; if more than two, add names in comments section.)

Payment Method

A payment method is not required to create your account. However, a payment method must be provided at the time of sample submission. For your protection, we cannot accept credit card numbers on this form. You will be contacted by telephone to obtain credit card information.