Provision New Institution - Ligarion Platform

Institution Information

Institution or Program Name *

The name as it will appear in the application

Legal Name *

Used in Stripe and for all billing purposes

Tax ID / EIN

Website

Subscription Plan

Select Plan *

Choose the subscription plan for this institution

Contact Information

Primary Email *

Primary Phone *

Street Address *

City *

State/Province *

Zip/Postal Code *

Country *

Institution Manager Account

An invitation email will be sent to the institution manager to complete their account setup.

First Name *

Last Name *

Email *

The invitation email will be sent to this address

Phone

Payment & Billing

Billing Information

A Stripe customer will be created automatically using the contact information above. An invoice will be generated with NET 30 payment terms.

Billing Contact Name

Optional - Leave blank to use institution manager name

Billing Contact Email

Optional - Leave blank to use primary email

Apply Discount Coupon

Check this box to apply the discount coupon configured in the TESTING_COUPON_100 environment variable. This will reduce the invoice amount for testing or promotional purposes.

Additional Information

Internal Notes