Fast, Accurate & Affordable Lab Testing in Georgia

Business Account Set Up

Application for Credit

Complete this form ONLY if you’d like to establish credit at Any Lab Test Now. Our terms are net 30 days. Any account that has an invoice reach 60 days will be temporarily closed until the account is within terms. If you prefer the simplicity of automated charges to your company credit card, please complete our CC Authorization form instead of this application for credit.

If you prefer, you may email the completed PDF to  Melanie@AnyTest.com or fax to 678-578-6384.

Company Information
Company Name*
Year Founded*
Contact Name*
Contact Phone*
Contact Email*
Total Number of Employees Subject to Testing*
Estimated Drug Screens Per Month*
Billing Address*
City*
State*
Zip*
Bank Reference
Bank Name*
Bank Phone*
Bank Address*
City*
State*
Zip*
Invoices
We would like our invoices:*
Email to Receive Invoices*
Mail Invoices To*
City*
City*
Zip*
Test Results
We would like the results of our employee tests:*
Email Results To:*
Fax Results To:*
Applicant authorizes Any Test, PC to contact its trade and bank references for credit information in connection with this application. The applicant further authorizes any person or credit agency to furnish to Any Test, PC any information that it may have or obtain in response to such inquires. Applicant hereby certifies that the foregoing figures and statements contained in this application or attached hereto are true and correct and are furnished to Any Test, PC for the purpose on inducing Any Test, PC to extend credit to the applicant. The individual executing this Application on behalf of the party seeking to establish credit hereby represents and warrants that he or she is duly authorized to execute and deliver this Application on behalf of such party and that such execution is binding upon such party. Applicant’s signature attests to financial responsibility, ability and willingness to pay invoices in accordance with Any Test, PC terms. Credit terms are Net 30 days from the date of invoice. Applicant agrees to pay Any Test, PC such payment by or on due date. If this account is given to an attorney for collection, or if suit is brought for collection, or if it is collected through probate, bankruptcy, or other judicial proceeding then Applicant shall pay to Any Test, PC all cost of collection, including reasonable attorney’s fees and court cost, in addition to other amounts due.
Applicant Name*
Job Title*