Traxon New Customer Request Form

New Customer Form

By filling out the below form, the user acknowledges and confirms that all information provided is the most up to date. The user also ensures and confirms the accuracy of all documents and information. The application process may take up to 4 business days to complete once submitted.

Customer understands payment in full is required at time of order release.

Customer Name*

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone*

Fax

Accounts Payable Contact Name*

First NameLast Name

Accounts Payable E-mail Address*

I confirm that I have read all terms and conditions presented in this form and have filled out said form with accuracy and to the best of my ability.*

Confirm

Once this form is submitted, you will be contacted by a Traxon representative to confirm receipt. Thank you for being a Traxon customer.