Consortium Enrollment

Consortium Enrollment
The purpose of this form is to alert the Fastest Labs Home Office that you want to enroll a client into the Fastest Labs Master Consortium!

By now you have already:
1. Set up the client in AIS
2. Recieved and added thier subaccount
3. Conducted a Pre-Employment Drug Test if necessary
4. Imported their roster and verified that it is updated
Once you submit this form:
1. A PandaDoc will automatically send for you to sign
2. Once you sign, your client will be emailed to sign
3. Once they sign, Enhouse America, LLC will sign
When all parties have signed:
1. Your client will be added to the selected Consortium
2. Your office will be billed the $50 annual fee for the first year
Your Information

This information will be used to add find your client in AIS and list you on the PandaDoc that is sent as a signer. Please use the name and email for the person signing the agreement on your behalf.
Your Franchise ID*
Clinic Name
List "city" or "location name" only. It will be listed as "Fastest Labs of {answer}.
Franchisee Fastest Labs Email*
example@example.com
Franchisee First Name*
Franchisee Last Name*
Client Info
Customer Name in AIS*
Customer ID in AIS*
Client First Name*
Client Last Name*
Client Email*
example@example.com
Consortium Selection
Consortium Selection*
Signature

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Your Information