New Customer Form

Manually Fill Out New Customer Form

Landmark Credit Application

Fields marked with * are required.

Shipping Address

Preferred Invoice Method:

Do you require Purchase Orders?

Are you A?

Additional Authorized Employees



If this account request is opened, I agree:

  1. New Customers must provide a CC to keep on file. This CC will be used for invoicing until a business relationship is established
  2. Rentals - You are agreeing to pay at the time of invoice. CC must be put on file for rentals. For new rentals a minimum $500 hold will be placed on CC until machines are returned
  3. For new service customers; We require a credit card to be put on file and a minimum got $500 hold will be placed on the card. Once service is completed & invoiced, we willl release the hold & run for correct amount
  4. To pay interest of 1.5% monthly (18%annum) service fee on any invoice past its due date
  5. To pay collection agency fees. attorney's fees and all court costs in the event that collection efforts become necessary. If payment is not made accordingly there will be a 3% Conv. Fee. This does not apply to rentals. Rentals must be paid at time of invoice & CC must be on file
  6. If you would like to be set up as Net 10/Net30, please let us know when emailing this back, you would like to get a credit review completed. Please ve aware a credit approved may not be given immediately
  7. Special order (non-stock) and electrical parts are NON-RETURNABLE. Other returns are accepted wuthin 30 days from date of purchase and charged a 30% restocking fee. Freight is not credited. Additional frieght might be charged. No Credit will be considered without prior written approval.
  8. If any equipment is hauled there will be additional charges for the hauling

This (item#4) does not apply to rentals. Rentals must be paid at time of invoice & CC must be on file.



We accpet Visa, MasterCard & ACH

Please call us at (503) 256-7330 with credit card payment information to complete your setup in our system.

For security purposes, please enter the characters from the box above: