New Customer Form Test

New Customer Form
Have a TICMS representative contact me?*
- Yes
- No
Date to Contact:
MM slash DD slash YYYY
Select your Level of Calibration*
- Platinum- ISO 17025 Accredited Calibration
- Gold- NIST Traceable Calibration
Tax Exempt*
- Yes
- No
Tax Exempt #:
Company Name:*
Company Phone #:*
Quality Contact Name:*
Quality Contact Email:*
Quality Contact Phone #:*
Quality Contact Cell #:

Ship to Address:*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
I prefer to receive my Calibration Certificates:*
- OLM (online)
- Printed & mailed
Choose your preferred method of shipping: (Please include account number)*
UPS #:*
Courier Name:
FedEx #:*
Customer Pick-Up:
Comments:
How did you hear about us?

Accounting Information
Please note the first transaction is C.O.D. You are always welcome to pay by credit card. Our terms are net 30 days. Please visit our Credit Application to get started: Credit Application
I prefer to receive my Invoices:*
- Emailed
Email Address for Invoices*
Accounts Payable Contact Name:*
Accounts Payable Email Address:*
Accounts Payable Billing Address:*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Phone #:*
Comments: