May 12th, 2008 Rate Change Request Form
Company Name:
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 May 12, 2008 Rate Increase
No, I do not want the May 12, 2008 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

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