Teledyne Imaging - Request for Credit Account

Request for Credit Account

TELEDYNE IMAGING GROUP
Please complete this online application

Teledyne Imaging 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 credit application.
Business Unit Selection
For which Teledyne business unit are you making this application for credit?
Show BU Selection if unassigned
Company Information
Company Type*

CorporationSole ProprietorshipPartnershipGovernment OwnedEducational Institution
Legal Corporate Name*
Subsidiary of
Division of
Date Established*

YearMonthDay
Date
Number of Employees*
Annual Sales*
Please specify currency
D&B Number
Federal Tax OR VAT #
If you are a customer in the USA you are required to send all copies of your tax exemption certificates on this application to the email address TDI_credit@Teledyne.com. For all countries other than the USA sending the tax exemption certificate documents is optional.
Street Address*
City*
Province/State*
ZIP/Postal Code*
Country*
Telephone*
Website
Your Market
If "Other", please specify
Specify Your Market
Market Relationship
Does your company use portals for invoice submission?
Corporate Officers
Senior Operations Officer*
Senior Financial Officer*
Accounts Payable
Contact name*
Telephone*
Include country code
State/Province*
ZIP/Postal Code*
Email for Invoices*
Billing Address*
Country*
Routing Information
Customer Location*
Teledyne DALSA division from which you will buy
Teledyne Sales Contact
Teledyne Sales Contact
For faster processing, please indicate the name of your Teledyne sales contact.
Trade References
First Reference Company Name
First Reference Company Email
First Reference Company Phone
Include country code
Second Reference Company Name
Second Reference Company Email
Second Reference Company Phone
Include country code
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. The applicant does hereby authorize Teledyne to conduct all credit investigations necessary for approval of this application. The applicant understands and accepts that Teledyne 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 uses only electronic invoicing delivery methods. Payment is only accepted by electronic wire transfer, paper cheques are not accepted.
Privacy Policy and Consent*

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*
Applicant's Job Title*
Verification
Please verify that you are human*
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Request for Credit Account

Please complete this online application

Business Unit Selection

Company Information

Corporate Officers

Accounts Payable

Routing Information

Teledyne Sales Contact

Trade References

Terms and Conditions

Terms of Sale

Verification