New Customer

Company Name:

Email Address:

Phone:

Fax:

Address Line 1:

Address Line 2:

State:

City:

Zip Code:

Primary Contact

Full Name:

Email Address:

Phone:

Administrative Contact

Full Name:

Email Address:

Phone:

QA/Cal Manager

Full Name:

Email Address:

Phone:

Calibration Requirements

Track Equipment by: Asset #Barcode #Serial #

Service Requirements:

ISO/IEC 17025 AccreditedNon-Accredited CalAccredited Calibration ISO 17025ANSI Z540.3NIST traceable calibration with data (ANSI Z540-1)NIST traceable calibration (No Data)PM (preventative maintenance) & Consulting ServicesRepair request/quote

Other:

Certificate Formatting

Certificate Date Format:

mm/dd/yyyymm/yyyydd/mmm/yyyymmm dd, yyyy

Calibration Interval:

No calibration due date requiredInterval

If an interval is chosen, how many months do you require?

1369122460120Other

Notification of Equipment due for Calibration:

YesNo

Sticker Date Format:

mm/dd/yyyymm/yyyydd/mmm/yyyymmm dd, yyyy

Delivery Information

Ship via: UPS/FedexUSPSOther

Account #:

Pick up and/or delivery location at your facility(if applicable): Yes

Accounting Information

Bill to same as ship to? Yes

Address Line 1:

Address Line 2:

State:

City:

Zip Code:

Purchasing Contact

Full Name:

Email Address:

Phone:

Accounts Payable

Full Name:

Email Address:

Phone:

Taxable?

YesNo

Tax Exempt ID:

(Tax exempt certificate required by law.)

Payment Method: Credit CardPurchase OrderOther

Additional Requirements

ACR Technical Services

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