Customer Information

Ticket Details

Primary Contact Information

Does your company or institution have an institutional iLab license?

Yes No

What is the name of your institution’s iLab administrator?

What is the job title / role of your institution’s iLab administrator?

What is the work email of your institution’s iLab administrator?

What is the phone number of your institution’s iLab administrator?

Are you part of a lab or research group that already uses iLab?

If you respond No, as you aren’t already associated with a lab or research group, iLab will create an account/group for you under the name of the Primary Contact listed above.

Yes No

What is the name of that lab or research group?

What is the name and contact information of that group’s administrative/financial contact?

Your lab’s accountant or Accounts Payable representative; if you’re paying with a purchasing or credit card, the information for the person named on the card.

The Primary Contact should be the person who is authorizing this request, such as the principal investigator (PI) of the lab or study or the director of the project or department.

Primary Contact Full Name

Primary Contact Job Title / Role

Primary Contact Company or Institution Name

Primary Contact Work Address

Primary Contact Work Phone

Primary Contact Work Email

Do you currently have a signed, executed contract with any UNC Core Facility?

Yes No

Financial Information

Only the Primary Contact and the designated Financial Representative will be able to approve quotes and service requests or pay invoices. If invoices will be paid by an Accounts Payable department rather than a specific person, please use that department’s email address (e.g., accountspayable@companyname.com) as the work email address below and leave the name information blank. If you plan to pay by procurement card or credit card, the cardholder’s information should be used here.

What is your preferred payment method?

Credit Card

Purchase Order

Financial Representative Full Name

The name of the person who will be designated as your Financial Representative in iLab (usually your accountant or Accounts Payable representative).

Financial Representative Job Title / Role

Financial Representative Work Address

Financial Representative Work Phone Number

Financial Representative Work Email

Can invoices be emailed to the Primary Contact and Financial Representative work email addresses above?

Yes No

How should invoices be submitted for payment?

Other Contacts

Would you like to include any other contacts on your account (e.g. administrative support personnel, lab members, managers, additional financial representatives)?

Yes No

Other Contact Details

You must include Name, Role, and Email for each contact.

Additional information

Please add any additional information you think will be helpful in getting your request resolved.

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External Customer Billing Information Form

Customer Information

Ticket Details

Primary Contact Information

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