Customer Form

Kirkpatrick Scales, Inc.
117 N. Chambers
Claremore, Ok 74017
Phone: 918-341-0309 / 800-340-0309
Fax: 918-341-0328

Thank you for visiting our Web site. Please fill out the form below and we will contact you as soon as possible regarding your request.

First Name

M.I.

Last Name

Address Line 1

Address Line 2

City

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E-mail Address

Phone

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When would you like to schedule an appointment for?

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Comments/Questions

Interested in:

Purchasing

Repair

Priority Service Contract

If Repair (from left - Interested in)