Newton Microbial Laboratory Customer Agreement & EFT/CC Authorization Form V2019.05

Newton Microbial Laboratory Customer Agreement
Customer Information

Please input your company information
Name of Your Company *
Company Address *
Phone Number *

Area Code Phone Number
Email *
example@example.com
Email for Invoice *
example@example.com
Effective Date *

Month Day Year
Date
Name of Company Owner/Representative *

First Name Last Name
Select Payment Terms Option *

$17 per Sample and $18 per Standard Overnight Shipping $17 per Sample and uses Company's Own Shipping Methods $23 per Sample and Free Overnight Shipping
Terms and Conditions
This is an agreement between Newton Microbial Laboratory and {nameOf}, herein referred to as “Company”.
The “Company” has the right to terminate this agreement, with or without cause, at any time.

The “Company” will be invoiced every Friday and the “Company’s” bank account or credit/debit card will be automatically drafted for the amount of the invoice the following Monday. Newton Microbial Laboratory will use the Electronic Fund Transfer (EFT)/Credit Card Authorization Form for payment that was completed by “Company.”

If there are any discrepancies, “Company” will inform Newton Microbial Laboratory in order for the invoice to be reconciled so a payment can be made.

The “Company” agrees to pay Newton Microbial Laboratory a sum of $17.00 per Spore Trap or Direct ID Sample Analysis.

The “Company” agrees to pay Newton Microbial Laboratory a sum of $18.00 per FedEx overnight delivery using an envelope; a sum of $28.00 per FedEx overnight delivery using a Pak; and a sum of $38.00 per FedEx overnight delivery using a Box.

The “Company” agrees to pay Newton Microbial Laboratory an additional sum of $5.00 per sample for which ‘Plus Service’ is selected.

The “Company” agrees to pay Newton Microbial Laboratory an additional sum of $5.00 for which ‘Expedited Service’ is selected.

This Agreement shall be effective as of {effectiveDate} (the “Effective Date”).

I, {ownerrepresentative}, acknowledge that I fully understand the fee schedule and terms of this agreement with Newton Microbial Laboratory.

Company Address: {companyAddress}

Company Phone: {phoneNumber}

Email: {email}

Email for Invoice: {emailFor}
The “Company” has the right to terminate this agreement, with or without cause, at any time.

The “Company” will be invoiced every Friday and the “Company’s” bank account or credit/debit card will be automatically drafted for the amount of the invoice the following Monday. Newton Microbial Laboratory will use the Electronic Fund Transfer (EFT)/Credit Card Authorization Form for payment that was completed by “Company.”

If there are any discrepancies, “Company” will inform Newton Microbial Laboratory in order for the invoice to be reconciled so a payment can be made.

The “Company” agrees to pay Newton Microbial Laboratory a sum of $17.00 per Spore Trap or Direct ID Sample Analysis.

The “Company” uses its own shipping methods to send samples to Newton Microbial Laboratory.

The “Company” agrees to pay Newton Microbial Laboratory an additional sum of $5.00 per sample for which ‘Plus Service’ is selected.

The “Company” agrees to pay Newton Microbial Laboratory an additional sum of $5.00 for which ‘Expedited Service’ is selected.

This Agreement shall be effective as of {effectiveDate} (the “Effective Date”).

I, {ownerrepresentative}, acknowledge that I fully understand the fee schedule and terms of this agreement with Newton Microbial Laboratory.

Company Address: {companyAddress}

Company Phone: {phoneNumber}

Email: {email}

Email for Invoice: {emailFor}
The “Company” has the right to terminate this agreement, with or without cause, at any time.

The “Company” will be invoiced every Friday and the “Company’s” bank account or credit/debit card will be automatically drafted for the amount of the invoice the following Monday. Newton Microbial Laboratory will use the Electronic Fund Transfer (EFT)/Credit Card Authorization Form for payment that was completed by “Company.”

If there are any discrepancies, “Company” will inform Newton Microbial Laboratory in order for the invoice to be reconciled so a payment can be made.

When the " Company" sends 3 or more samples in an individual package,
- The “Company” agrees to pay Newton Microbial Laboratory a sum of $23.00 per Spore Trap or Direct ID Sample Analysis.
- The “Company” agrees to pay Newton Microbial Laboratory a sum of $0.00 per FedEx overnight delivery using an envelope; a sum of $10.00 per FedEx overnight delivery using a Pak; and a sum of $20.00 per FedEx overnight delivery using a Box.
When the " Company" sends less than 3 samples in an individual package,
- The “Company” agrees to pay Newton Microbial Laboratory a sum of $17.00 per Spore Trap or Direct ID Sample Analysis.
- The “Company” agrees to pay Newton Microbial Laboratory a sum of $18.00 per FedEx overnight delivery using an envelope; a sum of $28.00 per FedEx overnight delivery using a Pak; and a sum of $38.00 per FedEx overnight delivery using a Box.
The “Company” agrees to pay Newton Microbial Laboratory an additional sum of $5.00 per sample for which ‘Plus Service’ is selected.

The “Company” agrees to pay Newton Microbial Laboratory an additional sum of $5.00 for which ‘Expedited Service’ is selected.

This Agreement shall be effective as of {effectiveDate} (the “Effective Date”).

I, {ownerrepresentative}, acknowledge that I fully understand the fee schedule and terms of this agreement with Newton Microbial Laboratory.

Company Address: {companyAddress}

Company Phone: {phoneNumber}

Email: {email}

Email for Invoice: {emailFor}
Owner/Company Representative Signature *

Clear

Electronic Funds Transfer/Credit Card Authorization Form

Newton Microbial Laboratory
COMPANY INFORMATION

Company Name: {nameOf}

Owner/Representative Name: {ownerrepresentative}

Company Address: {companyAddress}

Email for Invoice: {emailFor}

Effective Date: {effectiveDate}
PAYMENT AUTHORIZATION AGREEMENT

I, {ownerrepresentative}, hereby authorize Newton Microbial Laboratory to debit electronically to the selected payment method specified herein. This is authorization agreement is effective as of {effectiveDate} and is the remain in full force and effect until Newton Microbial Laboratory has received notification of its termination in writing. I agree to submit an updated Electronic Funds Transfer/Credit Card Authorization Agreement Form to make any changes to the information provided within this agreement.
Payment Method *

Bank Account Credit Card
Electronic Funds Transfer Info
Bank Name
Name on the Account

First Name Last Name
Account Type

Business Checking Business Saving Personal Checking Personal Saving
Routing Number
Account Number
Credit/Debit Card Info
Card Holder Name

First Name Last Name
Card Holder Email
example@example.com
Card Holder Phone Number

Area Code Phone Number
Due to PCI certification, we are not able to collect your credit card information through this online form. After completing and submitting this form, you will see a pop-up window with a direct link to Credit Card Authorziation Form. Please click and fill out the form and send it to us. Or, Our Laboratory staff will be contacting you to obtain your credit card information via email/phone. Thank you.
Authorized Signature *

Clear
All requested information is required. Newton Microbial Laboratory will send you a weekly invoice and automatically debit your bank account or credit card after the effective date. If any, please contact accounting@newtonlaboratory.com for any questions regarding this form. Thank you

Newton Microbial Laboratory Report Customization
Your Company Logo
If you would like to display your company logo in our lab report, please upload your logo here, otherwise skip this section.
Upload your company logo
Choose Your Report Type

Click on names to preview sample reports
Standard Report – Any elevated spore counts is emphasized with highlights compared with the control

No Comparison Report – Any elevated spore counts is NOT emphasized by any means compared with the control

Criteria Specific Report - Based on the testing company’s criteria, any elevated spore counts are emphasized with highlights compared with the control sample

Categorized Elevation Level Report – Based on the testing company’s criteria and definitions, any elevated spore counts are emphasized with highlights and words giving an indication of the severity of elevation or possible courses of action compared with the control sample

Numerical Elevation Level Report - Based on the testing company’s criteria and definitions, any elevated spore counts are emphasized with highlights and numeric ratings giving an indication of the severity of elevation compared with the control sample
Select Your Report Type *

Standard No Highlight Criteria Specific Categorized Elevation Level Numeric Elevation Level
Once you have made a selection of report type and submitted, our laboratory personnel will contact you with the company criteria form.
Submit and Set Up with Newton Microbial Laboratory

Submit Customer Agreement, EFT/CC Authorization Form and Report Customization Form
Should be Empty:

Newton Microbial Laboratory Customer Agreement

Customer Information

Terms and Conditions

Electronic Funds Transfer/Credit Card Authorization Form

COMPANY INFORMATION

PAYMENT AUTHORIZATION AGREEMENT

Electronic Funds Transfer Info

Credit/Debit Card Info

Newton Microbial Laboratory Report Customization

Your Company Logo

Choose Your Report Type

Submit and Set Up with Newton Microbial Laboratory