Account Application Form (Cash Only)

This is the Discount Equipment account application for cash / credit-card customers (payment term: Cash Only). You can download and complete the official form, or fill in the fields below.

Download the form

Download the PDF for the Cash / Credit Card Authorization form here. The form can be filled out on screen using Adobe Reader, or printed and completed by hand. Once signed, return it along with copies of the applicant's driver's license and the front and back of the credit card.

Filling it out on-screen requires opening the PDF in Adobe Reader, which can be downloaded for free here.

Account application

Applicant information

• Full name
• Company name
• Billing address
• City, state, ZIP
• Phone
• Email

Credit card authorization

• Cardholder name
• Card number
• Expiration date
• Security code (CVV)
• Billing ZIP code

Required attachments

• Copy of the applicant's driver's license
• Front and back copies of the credit card
• Signed authorization