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Step 1. Create an External Billing Account
If you already have a DNA CCIB Core Billing Fund #. you can move to
Step 2
directly.
PO number:
Description:
*
PI First Name:
*
Billing Code:
Academic Medical Center
For Profit Organization
*
PI Last Name:
*
PI Email:
*
Billing Address:
*
Account Manager's
Name:
*
Account Manager's
Phone:
*
Account Manager's
Email:
(All invoices will be sent electronically to the following email.)
*
Account Billing Manager's
Email:
Comments:
Sorry about this, but I have to ask you to answer the following question to stop spam.
*
Please reverse complement the following sequence: ATCG
* Required field
