New Customer Form

General Information

Contact Information



Business and Credit Information

Business / Trade References

(Please give reference to any 3 businesses that you feel apply.)




Payment Information

Contact Information If Different Than Above

Payment Information will be kept confidential. It will be kept ONLY by Broadview Instrumentation Services' Finance Department. If you wish to provide your credit card information verbally, please complete ALL other portions and return as instructed. For each transaction, a copy of invoice and/or receipt will be sent via email.

Billing Information If Different Than Above

Terms and Conditions

1. All invoices are to be paid within 10 days from the date of the invoice. Late payments are subject to 1% interest per month on the unpaid balance.

2. For ALL new customers, we do not accept Purchase Orders. All orders must be paid with a credit card. Credit card information must be provided before any services will be performed by Broadview Instrumentation Services, Inc. Once you have established a line of credit with Broadview Instrumentation Services Inc., you are welcome to send in you equipment on a purchase orders This may be sent via fax or email.

3. Claims arising from invoices must be made within 7 business days

4. By submitting this application, you authorize Broadview Instrumentation Services Inc. to make inquiries into the Banking and Business/Trade references that you have supplied

By signing below, you agree to all of the Terms and Conditions described above.