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balsangroup
2019-08-19T18:23:04+00:00
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*
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*
Please select the store or department you would like to contact.
Annapolis
Beltsville
Broomall
Colmar
Downingtown
Eagleville/Norristown
Waldorf
Main Office
Accounts Payable
Accounts Receivable
Human Resources
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Company Name
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Contact Name
*
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Are you the company owner?
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What is your title?
*
Owner's Name
*
First
Last
Address
*
Street Address
Address Line 2
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Armed Forces Americas
Armed Forces Europe
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ZIP Code
Phone
*
Mobile
Email
*
Select your store
*
Annapolis, MD
Beltsville. MD
Broomall, PA
Colmar, PA
Downingtown, PA
Norristown, PA (Eagleville)
Waldorf, MD (White Plains)
You may shop at any of our 7 locations with this account, but for our records we assign a home store.
PAYMENT INFORMATION
A/P Contact Name
*
First
Last
A/P Email
*
Would you like to keep a credit card on file
*
Yes
No
Credit Card #
Expiration Date
CVV
Licensing Information
EPA Certification #
State License #
Business Information
To help us better serve you please choose from the selections below that best describe your business
Primary Business Type
*
Residential
Light Commercial
Refrigeration
Facilities
Education
Government
Mechanical
Plumbing
Other
Please select one
Secondary Business Type
Residential
Light Commercial
Refrigeration
Facilities
Education
Government
Mechanical
Plumbing
Other
Customer Type
*
Install/Repair/Maintenance
New Construction
Other
Please select all that apply
Company Size
*
1 Truck
2-5 Trucks
6-9 Trucks
10-24 Trucks
25+ Trucks
Please select one
Primary Line of Unitary Equipment
*
Amana
American Standard
Armstrong
Bryant
Carrier
Coleman
Goodman
Lennox
Luxaire
Payne
Rheem
Ruud
Trane
York
Other
Please select one
If you selected other, please indicate your primary line here
*
Secondary Line of Unitary Equipment
*
Amana
American Standard
Armstrong
Bryant
Carrier
Coleman
Goodman
Lennox
Luxaire
Payne
Rheem
Ruud
Trane
York
Other
Please select one
If you selected other, please indicate your secondary line here
*
Primary Line of Ductless Equipment Sold
*
Bosch
Carrier
Comfort Aire
Daiken
Freidrich
Gree
Fujitsu
Lennox
LG
Mitsubishi
Panasonic
Rheem
Other
None
Please select one
If you selected other, please indicate your ductless line here
*
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Request a quote
Name
*
First
Last
Company
*
Customer #
Please include if available. This will expedite your quote.
Email
*
Phone
*
Product Description
*
Please enter as many details as possible. Part/model numbers will help expedite your quote.
Please select the state of your local store
*
Maryland
Pennsylvania
×
Return Request Form
Returns must be within 30 days and in original and undamaged packaging. Returns may be subject to a restocking fee. Special order items are not returnable.
Date
*
Date Format: MM slash DD slash YYYY
Company
*
Name
*
First
Last
Email
*
Phone
Your PO/Reference #
*
RETURN ITEMS
Return Location
*
Annapolis
Beltsville
Broomall
Colmar
Downingtown
Eagleville/Norristown
Waldorf
Reason for Return
*
New/Unused - Wrong item/Not Needed
Defective
Warranty
Homeowner Name
*
First
Last
Installation Address
*
Street Address
Address Line 2
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Item 1
Qty
*
JS Part #/MFG Part #
*
Item Serial Number
*
Johnstone Supply Invoice #
Your PO #
Purchase Date
*
Date Format: MM slash DD slash YYYY
Check to add another item
Add
Item 2
Qty
*
JS Part #/MFG Part #
*
Johnstone Supply Invoice #
Your PO #
Purchase Date
*
Date Format: MM slash DD slash YYYY
Check to add a third item
Add
Item 3
Qty
*
JS Part #/MFG Part #
*
Johnstone Supply Invoice #
Your PO #
Check to add a fourth item
Add
Item 4
JS Part #/MFG Part #
*
Qty
*
Johnstone Supply Invoice #
Your PO #
Purchase Date
*
Date Format: MM slash DD slash YYYY
Check to add a fifth item
Add
Item 5
JS Part #/MFG Part #
*
Qty
*
Johnstone Supply Invoice #
Your PO #
Purchase Date
*
Date Format: MM slash DD slash YYYY
Request A Quote
New Account?
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