WCS | Rate Change Request Form

January 2010 Rate Change Request Form

Company Name:
Email Address:
Bill to:
Address:
City:
State:
Zip Code:
Contact:
Phone:
Fax:
Email:
Ship to:
Address:
City:
State:
Zip Code:
Contact:
Phone:
Fax:
Email:
Scale Model:
Scale Model Number:
Scale Serial Number:
Equip ID#:


Payment Type: (Select One)
Purchase Order: Credit Card:
Watts will contact you for Credit Card information or mail you an invoice with PO# referenced


Select one:
Yes, I want the January 2010 Rate Increase
No, I do not want the January 2010 Rate Increase
Please have a Salesperson contact me to discuss options to automate my mail processing
I am no longer using a Watts Postage Systems Scale