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Credit Application

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



You are required to attach all copies of your tax exemption certificates on this application.

(optional; required for US; 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

Trade references must be included below


Terms and Conditions


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