Customer Information Form

Customer Information
Company: (Required)
Email: (Required)
Address 1:
Address 2:
Address 3:
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.


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