New Customer Proficiency Testing Enrollment Form

Enrollment Information

Enrollment Information

Identification Information

Identification Information
Current/previous account ID (if known)

Contact Information of person completing this form

Contact Information of person completing this form
Example: 123-456-7890

Type Of Testing Site For This Order

Type Of Testing Site For This Order

How did you find us?

How did you find us?
(If you have more information, please add it to the text area provided below.)

Shipping Information

Shipping Information
Example: 123-456-7890

Billing Information

Billing Information
Example: 123-456-7890

Send Reports To

Send Reports To
Example: 123-456-7890

Consultant Information (optional)

Consultant Information (optional)
Example: 123-456-7890

Accreditation Agencies

Accreditation Agencies

Score Transmission To Accreditation Agency(ies)

Score Transmission To Accreditation Agency(ies)
All applicable scores will be sent to designated agencies by default unless specified below.

Order Information

Order Information

Please note:

  • Online Training and Competency, Assayed Sample Sets, AUDIT Linearity, and CEQAL Accuracy Monitoring have separate order forms.
  • Only Quality Evaluation (QE) and Additional Sample products may be ordered in multiple quantity. All others indicate quantity of 1.
  • Customers wanting to enroll only in certain events, please indicate so in the Order Comments section. You will only be charged for events enrolled.

PT07000

$15.00

Download the Additional Products form.

Fill it out, save it and then upload it using the upload option below.

Order Total

Order Total
Add Total Price column

$80.00

Add Subtotal and Annual Processing Fee

Payment Information

Payment Information

Verification

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This step is to verify this form is being completed by a person and not a computer.