Name:

Email:

Address:

Do you confirm that you are a researcher carrying out scientific R&D, either legitimately as an independent researcher or in association with a formally recognized corporation, organization or institution such as a University or Research institute?

YesNo

Do you confirm, verify and attest to the fact that you will purchase Everyday Basis products solely for scientific research and development, and do you agree that this is the sole intended use for with Everyday Basis is offering products for purchase?

YesNo

Your Current Age is (years):

Please upload a valid government issued Photo ID to confirm your age and identity: *

Do you confirm that you are authorized to open this Everyday Basis account, either on behalf of yourself as an independent researcher or on behalf of your company, organization or institution as a formally authorized employee, representative or member?

YesNo

Name of the Company, Organization or Institution with which you are affiliated (if no affiliation, please enter "Independent Researcher":

Please upload a valid proof of employment or academic affiliation (such as organizationally issued Photo ID, business card, payroll stub or officially issued letter or document) to confirm your engagement with the company or organization named above: *