LELAP

* Contact's Name
* Contact's Email	(Email address of the facility representative who shall be the primary contact for lab accreditation matters)
* Contact's Phone

* Facility Name	(Name as it shall appear on accreditation documents)
* Physical Address	(Street)
* Physical City
* Physical State
* Physical Zip
Physical Country
* Billing Address	(Street or P.O. Box) Same as the physical address
* Billing City
* Billing State
* Billing Zip
Billing Country
* Mailing Address	(Street or P.O. Box) Same as the physical address
* Mailing City
* Mailing State
* Mailing Zip
Mailing Country
* Purpose and Type of Application
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