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Name of Client/Company

Please provide the legal name of the entity that holds License for Manufacturing/Fabrication, Sale, Distribution, Testing, Storage, Wholesale, Pharmacy, Retail Sale. In all other cases, mention the name and address of work, business or authority.

Name of Owner/Director/Partner

First Name

Last Name

Email Address (Preferably official)

At your discretion, please put Email address (preferably official) of Owner/Director/Partner/ Quality Control In charge/ Qualified person/Focal Person/Authorized Person

Subject

Let us know if you have any inquiries about the following services. For example, FDA approved Lab Testing services, Export Promotion services, etc.

Message

Name of Authorized person for working with LYF Research

Authorized person may be Owner, Director, or Partner, Quality Control In-Charge, Qualified Person, Manager, Officer, or Employee who is well versed, authorized bears the authority to work and sign on behalf of client that conducts Manufacturing/Fabrication, Sale, Distribution, Testing, Wholesale, Pharmacy/Retail Sale. In all other cases, mention the address of work, business or authority.

First Name

Last Name

Address of Principal place of business

Address of Licensed place of manufacturer, importer, exporter, fabricator, wholesaler, distributor, hospital, pharmacy, university, institution, department etc.

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country