• Welch Equipment COD Customer Request Form

  • By completing the below, I (the customer) acknowledge that this account is being set up as a Collect on Delivery (COD) account and a binding agreement that payment is due at time of service.

  • (if exempt, please provide copy of exemption)

  •  /  /
    Pick a Date
  • Clear
  •  -  -
    Pick a Date
  • This box to be completed By Welch Equipment

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  • Should be Empty: