New Client Form

 

Thank you for selecting Vision Analytical Lab Services for your particle characterization requirements.  This for is to be used by new customers and will be used to establish a working account with Vision Analytical.  Please fill this form out as accurately as possible.  If you have any questions, please contact us at Lab@ParticleShape.com or at 305-801-7140.

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*

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?

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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