New Customer Signup Form

New Client Application

YOU'RE ALMOST DONE! Simply Review > Sign > Submit

REVIEW: Please review the following information you've submitted.

SIGN: If everything looks correct, click in the signature field next to the BLUE ARROW at the bottom of the form and SIGN.

SUBMIT: your application using the blue "AGREE & SIGN" button that will appear at the bottom-right of the screen.

Note: You can print a PDF of your document or receive an email confirmation after clicking submit.

Please Review the following information you've submitted for accuracy: 









We warrant the foregoing information to be true. I, AN AUTHORIZED OFFICER, grant permission to investigate the references, including commercial and consumer credit checks. I agree to pay within agreed terms. A late charge of 1.5% per month may be imposed upon the accrued, unpaid balance of an invoice not paid within terms. We agree to pay assessed interest up to the highest amount allowed by law. If the account is placed for collection, or with an attorney, whether a lawsuit is filed or otherwise, or if services of an attorney are required to protect the interest of Delco Innovations & Trend Medical, LLC, we agree to pay all costs and reasonable attorney's fees, and further consent that jurisdiction and venue shall be in the circuit courts of Northampton County, Pa. We hereby grant permission to Delco Innovations, LLC & Trend Medical, LLC and its subsidiaries to send advertising and promotional materials to the email(s) and fax number(s) listed above. This operates as consent under the 47 U.S.C 227 of the Telephone Consumer Protection Act.


To induce Delco Innovations, LLC & Trend Medical, LLC. to sell goods to the applicant, the undersigned agrees to the above terms which are herein incorporated and personally guarantees and agrees to pay, when due and upon demand, the full amount of any indebtedness, including attorney fees and costs incurred for collections, owed to Delco by the applicant in connection with such sales.


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Signature Certificate
Document name: New Client Application
lock iconUnique Document ID: 1606ce94608e9941444f3bf5e9e5bb131f5498d3
Timestamp Audit
April 3, 2020 2:20 pm EDTNew Client Application Uploaded by Brandon Boyer - IP