Welcome — Let’s Build Your Legacy Account

Choose Request Type:

Other
1. Company Information
Company Name
Optional: Parent Account
Website
Phone Number
Format: (000) 000-0000.
2. Billing Information
Billing Contact

First NameLast Name
Billing Email
example@example.com
Billing Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
3. Shipping Address
Same as billing?
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
4. Payments
Requested Payment Terms

Other
Enroll a Card for Automatic Billing
If you selected automatic credit card billing on your Client Setup Form, simply use your first invoice to securely add the card you would like kept on file.

When paying your first invoice:
- Enter the credit card you wish to use for recurring billing
- Choose Save Payment Method during payment, if available
- Future invoices will be processed according to the billing preference you selected during onboarding
For security purposes, Legacy does not collect or store card information by email or paper forms.
Please select how you would like to receive invoices:

Other
How would you like your credit card processed?

Other
Any PO or billing reference requirements
I understand that Net terms must be applied for and approved in writing by Legacy Environmental Laboratory. Until approval is granted, payment is due upon receipt. Late fees of $25 will apply to invoices unpaid after 14 days past due.
EIN

1. Company Information