Company Information

Company Name*

Federal ID Number

DUNS (D&B) #

NAICS Number or Description of Your Main Industry*

Company Details

Address Line 1*

Address Line 2

City*

State*
—Please choose an option—AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming

Zip Code*

Country*

Website

Order Placement Preferences/Instructions

Vision Analytical requires either a Purchase Order or credit card information for each sample submission. Which will be your company's preferred method?*
Purchase OrderCredit Card

If Purchase Orders are preferred:

1. Does your company require PO Acknowledgement?
YesNoUnsure

2. Does your company issue hard copies?
Yes, a physical, hard copy of each PO will be providedNo, we process orders with a "verbal" PO onlyNo, we will provide a PO number, however, we do not issue hard copiesN/A Credit card is preferred

3. Who should we contact with any inquiries regarding the PO? (i.e. amount discrepancies, expiration, terms, etc.)

Purchasing/Procurement Contact Name

Email Address for Purchasing/Procurement

Phone Number for Purchasing/Procurement

Special Invoicing or Purchase Order Instructions (250 chars left)

Accounts Payable Information
PLEASE NOTE: All invoices will be sent via email. Vision Analytical's payment terms are Net 30.

Accounts Payable Contact Name*

Email Address for Accounts Payable Contact*

Email Address for Submitting Invoices*

Phone Number for Accounts Payable*

Comments

Please provide any additional information you'd like us to know here.
Comments (250 chars left)

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