Our commitment is to carry only freediving gear and equipment, designed and manufactured by the most reputable companies who - just like us - cater exclusively to freedivers and freedive hunters.

 

DIRECTIONS: Please print form.  Fax completed form to 916-273-6566.

Download Application in PDF Format

Corporate Information
Corporate Name
Corp. Officer
Email
Street Address
 
City State Zip
Phone Fax
Federal ID State ID    
Store Shopping Information
Ship To
Street Adddress
 
City State Zip
Phone Fax
Federal ID State ID    

Billing Information
Card Holder
Card Type Card Number Retail Area
    Expiration CVV
Billing Address
City State Zip
   
 
Retail Information
Retail Dive Store Offer Internet Sales Offer Product by Mail
Residential Area Industrial Area Retail Area
Store Hours Days Open    
Authorized Buyers Name Position
Current Suppliers
Company Name Contact Terms
 
Statement of Facts
I hereby state that all of the information provided above is true and correct to the best of my knowledge and I authorize Triton X to check references I have provided and also my bank for the purpose of extending me and/or my firm credit

Signature ______________________ Date ____ Print Name ______________________
Account Policy
In the event this account is delinquent and satisfactory arrangements have not been made for payment, all legal, attorney fees, and collection costs will be assumed by debtor. I understand that Triton X reserves the right to discontinue selling any product to the above named store at its own discretion. By applying for credit, being accepted, and signing this application I agree to the above terms and conditions

Signature ______________________ Date ____ Print Name ______________________