Please fill out all information. By completing you are authorizing your signature.

Company Information

Contact Name(Required)
MM slash DD slash YYYY
Company Owned or Leased?(Required)
Reselling the equipment you purchase?(Required)

Accounts Payable Contact

Contact Name(Required)
Billing Address(Required)

Business/Trade Reference 1


Business/Trade Reference 2


Business/Trade Reference 3


Credit Request

Terms Requesting(Required)
  1. Applicant acknowledges liability for payment for amounts due to Trifecta Networks, LLC for delivery of products. If Trifecta Networks, LLC has to take action to collect any balanced owed, applicant agrees to pay ALL cost and expenses incurred in collection, including but not limited to attorney's fees, court cost, and interest thereon at the then maximum legal rate.
  2. By signing this application, you authorize Trifecta Networks, LLC to make inquiries into the banking and business/trade references that you have supplied.

You also agree to pay according to the terms quoted on the sales order. All past due invoices are subject to interest charges at the maximum allowable legal rate.

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