Corporate Registration – Aurum Labs Client Portal

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1 COMPANY INFO

2 LICENSE INFO

3 ADD USERS

Parent Business ID
Business Verification
Company Name*
Business Owners Name*
First Last
Business Owner's Phone Number*
Business Owners Email Address*

This will be your username
DBA (Enter company name if not applicable)
Federal Tax ID #
Main Business Team Member
Billing Address
Billing Address*
Street Address Address Line 2 City State ZIP Code
Upload Company Logo
Logo

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License Information
License #*
License #1 File
Accepted file types: jpg, pdf, csv, xlsx, png, docx, doc, xls.

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1st Location Address*
Street Address Suite or Unit City State ZIP Code
Additional Licenses/Facilities? Check all that apply and fill out the additional information below:
- Second License
- Third License
- Fourth License
- Fifth License
- Sixth License
Second License #
License #2 File

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2nd Location Address
Street Address Suite or Unit City State ZIP Code
Third License #
License #3 File

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3rd Location Address
Street Address Suite or Unit City State ZIP Code
Fourth License #
License #4 File

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4th Location Address
Street Address Suite or Unit City State ZIP Code
Fifth License #
License #5 File

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5th Location Address
Street Address Suite or Unit City State ZIP Code
Sixth License #
License #6 File

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6th Location Address
Street Address Suite or Unit City State ZIP Code

ADDITIONAL USERS

Name	Select all roles that apply:	Phone	Email (this will be their username)	Actions
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Additional Information
Is there anything else we should know about your company?
Do you want to be added to our Email Newsletter?
- Yes
Mailchimp Parameter Pass
I have read and agree to the payment terms, terms & conditions and privacy policy*
- Yes
Payment Terms
Terms & Conditions
Privacy Policy
Phone
This field is for validation purposes and should be left unchanged.

Already have an Account?

Discount Code
Mail Chimp Addition
Service
Company Name*
Name*
First Last
Select all roles that apply:
- Test Results Contact (access to testing results)
- Compliance Contact (contact for questions about orders)
- Billing Contact (will receive invoices)
Phone*
Email (this will be their username)*
License #*
Address
Street Address Address Line 2 City State ZIP Code
Second License #
Second License Address
Street Address Address Line 2 City State ZIP Code
Third License #
Third License Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Fourth License #
Fourth License Address
Street Address Address Line 2 City State ZIP Code
Fifth License #
Fifth License Address
Street Address Address Line 2 City State ZIP Code
Sixth License #
Sixth License Address
Street Address Suite or Unit City State ZIP Code
Email
This field is for validation purposes and should be left unchanged.