Customer Info Form | Barricade Flasher

Customer Information Form

New Customers fill in the form below so that we may enter you in our system to save some time when ordering equipment or services.

Existing Customers fill in the form below to keep us up to date with changes in your customer file.

We appreciate your continued support!

Phone Inquiries: (800) 424-8964

(Support available 24/7)

Company/Customer

Customer Contact

Customer Phone

Customer Fax

Customer Email Address

Customer Address

Street - Line 1

Street - Line 2

City

State

Zip Code

Country

Accounts Payable (A/P) Contact

A/P Phone

A/P Fax

A/P Email Address

A/P Address (if different than Company)

Street - Line 1

Street - Line 2

City

State

Zip Code

Country

Preferred Method of Billing *

Mail

FEIN # (Federal Employer Identification #)

Tax Exempt *

Yes

Tax Exempt #

Is a P.O. required on the billing? *

Yes

Additional Comments

Contact Us Today!

800.424.8964

6610 S. 13th Street

Oak Creek, WI 53154

Phone: (414) 764-1790

Fax: (414) 764-9563

Email: info@barricadeflasher.com

W-3946 County Rd H

Markesan, WI 53946-8139

Phone: (920) 398-2990

Fax: (920)-398-3452

Email: info@barricadeflasher.com

506 Emily Rd

Mazomanie, WI 53560

Phone: (608) 795-2241

Fax: (608) 795-2242

Email: info@barricadeflasher.com