New Customer Form | Biomedical Services

Email Subject *

Contact Name *

Contact Job Title

Phone Number *

Email Address *

Company Name

Ship to Address *

Bill to Address *

Payment Method *

Payment Terms

Terms requested here are subject to Biomedical Services' approval

Send Invoice to Name

Send Invoice to Email *

Accounts Payable Contact Person *

AP Contact Phone

AP Contact Email *

Accounts Payable additional Information

Return Shipping

We typically ship via FedEx 2nd Day and add the cost to the bill. We have daily FedEx Express (not Ground) pickups. Customers can provide their own shipping label. For other carriers, customers must arrange pickup from our facility.

Additional Contacts for the account

Please Specify Name, job title, phone number, email address.

Any other information

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