Provision New Institution - Ligarion Platform

Institution Information

Institution or Program Name *

The name as it will appear in the application

Legal Name *

Used for billing records and official account documents

Tax ID / EIN

Website

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

This creates a pending billing contact only. It does not start a trial, service term, renewal clock, or invoice. Provision the correct license from Licensing after creation.

Billing Contact Name

Optional - Leave blank to use institution manager name

Billing Contact Email

Optional - Leave blank to use primary email

Additional Information

Internal Notes