Customer Information Form.

Please fill in information below.

Please complete the following items and include requested names, phone and fax numbers and email addresses. We require NAICS code(s) or SIC code for your company. Assisrtance in obtaining the proper NAICS code(s) for your organization can be obtained at www.census.gov/epcd/www/naics.html or www.naics.com/search.htm. In order to promptly process your order, we need this information back as soon as possible.

All Red Areas Are (required)
Customer Information
Company Name:
Email:
Address 1:
Address 2:
Address 3:
Ferderal Tax ID #:
NAICS or SIC MUST be filled out
NAICS:
SIC:
Purchasing Department Information
Contact:
Phone:      Fax:
Email:
Accounts Payable Information
Contact:
Phone:      Fax:
Email:
Quality Manager Information
Contact:
Phone:      Fax:
Email:
Receiving Department Information
Contact:
Phone:      Fax:
Email:
Document Control Information
Contact:
Phone:      Fax:
Email:
E-Commerce Information
Contact:
Phone:      Fax:
Email:
Please indicate how you will convey document to Barium & Chemicals, Inc. as well as how you wish invoices and documents be sent to your company.