QSPF-050-4 Rev C-CUSTOMER INFORMATION FORM.pdf
PDF 241 KB Posted
- Contract number
- 26-532EPA-LAB53-P-84420
- Issued by
- Illinois
About this file
This document is a Customer Information Form from Gold Standard Diagnostics (GSD), a company located at 620 Cantrill Drive in Davis, California. The form is designed to collect comprehensive contact and shipping details from potential customers, with a quality assurance (QA) release revision dated 04/14/2020. The form requires detailed information across multiple sections including contact information, accounts payable contact, shipping address, shipping method, and sales tax information.
The form is a standard template for capturing essential business information needed to process orders and establish a commercial relationship. It includes fields for contact names, company details, billing and shipping addresses, communication methods, and tax-related information. The document emphasizes the importance of completing all fields, noting that incomplete information could result in order or shipment delays. The form provides options for shipping methods (prepay/add or customer account) and requires tax exemption certificates if applicable. The form is part of GSD's administrative process for onboarding new customers or updating existing customer records.
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Text version
QSPF-050-4 Rev C
QA RELEASE
Effective Date: 04/14/2020
CUSTOMER INFORMATION FORM
Please TYPE in all fields and do not abbreviate.
All fields are required, if not complete this could result in delay of order/shipment.
If not applicable, please type N/A
DATE:
Rep. Name:
CONTACT INFORMATION
Contact Name
Company Name
Company Street Address
City State Zip Code
Country Company Phone #
Email Address
ACCOUNT PAYABLE CONTACT
AP Contact Name
AP Phone # AP Email
Billing Address 1 Invoicing Email
Billing Address 2 State
City Zip Code
SHIPPING ADDRESS
Shipping Address 1 City
Shipping Address 2 State
Attn: Zip Code
SHIPPING METHOD (If none checked, default will be pre-pay and add)
☐ PREPAY/ADD ☐ CUSTOMER ACCOUNT: ACCOUNT #
CARRIER NAME:
SALES TAX INFORMATION
If customer is Exempt or Direct Pay Permit a certificate Must be provided
State Tax ID #
Reseller #
620 Cantrill Drive · Davis, CA 95618 · (530) 759-8012 ·Finance@gsdx.us mailto:Finance@gsdx.us
| DATE: |
| Rep Name: |
| Contact Name: |
| Company Name: |
| Company Street Address: |
| City: |
| State: |
| Zip Code: |
| Country: |
| Company Phone: |
| Email Address: |
| AP Contact Name: |
| AP Phone: |
| AP Email: |
| Billing Address 1: |
| Invoicing Email: |
| Billing Address 2: |
| State_2: |
| City_2: |
| Zip Code_2: |
| Shipping Address 1: |
| City_3: |
| Shipping Address 2: |
| State_3: |
| Attn: |
| Zip Code_3: |
| PREPAYADD: Off |
| SHIPPING METHOD If none checked default will be prepay and add: Off |
| CUSTOMER ACCOUNT ACCOUNT: |
| CARRIER NAME: |
| State Tax ID: |
| Reseller: |
File details come from the government source that posted it. Updated .