PIONEER SCALE new customer

PIONEER SCALE

New Customer Form
Company Name
Primary Company Contact
Email
example@example.com
Primary Phone Number
ext.
Fax Number
Business Type
Billing Address
Shipping Address
County
Tax I.D. Number
Please send a copy of Certificate
Designated email address for test and service reports
example@example.com
Designated email address for invoices
example@example.com
***Authorized to Issue/Request: Service Calls only, Purchases only, issue po's, or all the above*
Accounts Payable Contact
Title
Email Address
Email Address
example@example.com
Authorized to
Secondary Contact
Title
Phone#
Email Address
example@example.com
Authorized to
On Site Contact
Title
Phone#
Email Address
example@example.com
Authorized to
Do you require a Purchase Order Number? Yes
Additional Information
**If your company is tax exempt, we will need a copy of our State Tax exempt form** *All Test & Calibration and Service Calls are a 4 hour Minimum Charge**

Pioneer Scale Office Locations

Benton, Arkansas 950 Dale Avenue Benton, AR 72015

Longmont, Colorado 1650 Skyway Dr. Unit 2 Longmont, CO 80504 (303) 232-5656

Duncanville, Texas 1219 Crest Lane Dr. Duncanville, TX 75137

Texarkana, Texas 1607 B. N. Robison Rd. Texarkana, Texas 75501

2101 Congo Road, Suite 1000 I Benton, Arkansas 72018-1255 | www.pioneerscale.com
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