Please provide all the information requested.
New Lab Registration
Username:
*
Password:
*
Confirm Password:
*
Your Name:
Company Name:
*
DBA Names (Please list all that apply):
Street Address:
(Line 1)
*
(Line 2)
City:
*
State:
*
Zip:
*
Phone:
*
Ext:
Fax:
Email:
*
Insurance Agreement: Any claims for loss or damage must be made within 30 days of the date of request for pick up. All deliveries are covered for a maximum of $100.00 in value. OTD is not responsible for any damage or breakage if item is not properly packaged and labeled correctly.
I have read and agree to the above terms
*
*
Required Fields
Copyright © 2006 OTD, Inc. All Rights Reserved.