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Credit Application

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
You are required to attach all copies of your tax exemption certificates on this application.
(optional; REQUIRED for customers in USA; 4 MB max)
Corporate Officers
Accounts Payable
Routing Information
Teledyne DALSA Sales Contact
For faster processing, please indicate the name of your Teledyne DALSA sales contact.
Trade References
Terms and Conditions

Terms of Sale

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. The applicant understands and accepts that Teledyne DALSA monitors accounts on an ongoing basis and will share trade information with other credit grantors and reporting agencies from time to time. Terms of credit must be approved and are not automatically granted. I understand and accept that Teledyne DALSA uses only electronic invoicing delivery methods.

You consent to the use of this information for the purpose described above.
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By submitting this form, the personal information you supply will be used by Teledyne DALSA sales representatives and/or our distributors as necessary to respond to your enquiry and provide you with requested information or support. Please refer to our privacy policy for more information on how we use and store your personal information.