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Credit Application and Agreement

Please complete this online application. You may also be asked to supply copies of relevant tax exemption certificates. Teledyne DALSA keeps submitted information in strict confidence in accordance with our Privacy Policy.

* Fields marked with an asterisk are required. Without this information, we cannot process your application.

Company Information
* Company Type:	Corporation Sole Proprietorship Partnership
* Legal Corporate Name:
Subsidiary of:
Division of:
D&B #:
Website:
* Address:
* City:
* Province/State:
* Country
* ZIP/Postal Code:
* Telephone:
* Federal Tax #: (US only)	You are required to attach all copies of your tax exemption certificates on this application.
* Attachment	(optional; required for US; 10 MB max)
Market:	If "Other", please specify:
Market Relationship:	OEM System Integrator End User Other
Corporate Officers
* President:
* Senior Financial Officer:
Accounts Payable
* Contact name:
* Email :
Routing Information
* Customer Location	North/South America Europe Asia Asia Pacific
* Teledyne DALSA Division from which you will buy	Machine Vision (cameras, frame grabbers, software...) Semiconductor (MEMS, wafer foundry services...) Professional Imaging (large area image sensors...) Rad-icon Imaging (X-Ray)
Teledyne DALSA Sales Contact
Teledyne DALSA Sales Contact	For faster processing, please indicate the name of your Teledyne DALSA sales contact.
Trade References Trade references must be included below
* Company Name 1:
* Contact Email 1:
* Company Name 2:
* Contact Email 2:
Terms and Conditions
	Usual terms of sale are payment in full thirty (30) days from date of invoice, unless otherwise specified in writing, by the seller. Default of payment may result in a 1.5% monthly interest rate charge (18% per annum) on all past due amounts. The applicant does hereby authorize Teledyne DALSA to conduct all credit investigations necessary for approval of this application. Terms of credit must be approved and are not automatically granted. I understand and accept that Teledyne DALSA uses only electronic invoicing delivery methods. Privacy Policy and Consent: I consent to the use of this information for the purpose described above.
*	I accept the terms and confirm that I am authorized to make this application on behalf of the company represented on this application.
* Applicant's Name
* Applicant's Email
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- Teledyne DALSA is a global leader in high performance digital imaging and semiconductor technology, headquartered in Waterloo, ON, Canada.
  
  Teledyne DALSA is a Teledyne Technologies company.
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Teledyne DALSA - A Teledyne Technologies Company

Credit Application

Contact

Website

Credit Application and Agreement

Company Information

Corporate Officers

Accounts Payable

Routing Information

Teledyne DALSA Sales Contact

Trade References

Terms and Conditions

Submit Application

Our Company

Imaging Products

Semiconductor Services

Who We Are

Find Us On

Log in to your Teledyne DALSA account: