A.S. Chemical Laboratories - Application Form

A.S. Chemical Laboratories Inc. - Application Form










  1. Provider pays wholesale price for all tests.
    • If invoiced, Provider is billed bi-weekly for the laboratory work performed by A.S.C.L. Inc. Payment terms are net 15 days.
    • If accounts are not kept current A.S.C.L Inc. will make appropriate collection efforts to bring the account up to date.
    • A.S.C.L. Inc. reserves the right to assign credit limits to accounts.
    • If credit card is your method of payment, the card is charged once testing is complete and report sent.



  2. Provider is responsible to ensure patients know they must submit full payment with their sample. Credit Card or Cheque.
    • If patient chooses to pay with Credit Card a Credit Card Authorization must be completed.
    • Patient must enclose full retail price plus HST with sample.
    Note: Patient Pay is not available for LifeLabs.



  3.  
    By submitting this form, I have read the payment options and understand how each option works. I will abide by the terms and conditions of the option I have selected.  I understand this option will apply unless I submit a request to change my preferences. I further certify that I am a member of a regulated health profession.