Davis Sequencing New accounts

Thank you for taking the time to register on our new account on-line registry. We will use this information for billing purposes only. This information is for OUR company use and WILL NOT be distributed to outside businesses or vendors. To register your information, simply fill out the form below and click on the submit button. When submitting samples, please use a Purchase Order (PO) number or a credit card number. We do not assign account numbers. If you have any questions about this form or about new accounts, please contact our Accountant, Dan Villanueva. Thanks again for your patronage.

New Account Registry Form

How did you find out about our services?

If you were referred to us by a colleague, please type in their name below so that we can thank them.

1) Type of Customer

2a) Contact Person #1

2b) E-mail

3a) Contact Person #2

3b) E-mail

4) University or Business Name

5) Department or Lab

6a) Billing Address

6b) City

6c) State/Province

6d) Zip Code

6e) Country

7a) Phone (with area code)

7b) Fax (with area code)

8a) Accounting Contact Person

8b) Accounting Phone (with area code)

8c)Accounting Fax (with area code)

8d) Accounting E-mail

9) Web Site Address

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