Application for Open Account

This application is for Public Safety teams and Government Agencies only. For Reseller, Individual, or Company applications please reach out to [email protected].

"*" indicates required fields

Billing Information

Department Name*

Billing Contact*

Billing Address*

Billing Phone

Billing Email*

Preferred invoice delivery method*

Select up to 2 choices.

Email to Billing Email Above

Mail to Billing Address Above

Other (See Comments Below)

Comments

Please add any additional comments here.

If your shipping information is different than your billing information, please fill out the shipping section at the end of this form. If not, that section may be left blank.

Order Information

Is a purchase order required?*

PO Required for orders over:

Persons authorized to place orders without a purchase order

Will partial payments be made on partial shipments, or must deliveries be complete for payment?*

Partial shipments are okay

Complete shipments only

Please ask upon order

Tax Information

Tax Exempt Number

Tax Exempt Certificate

Drop files here or

Max. file size: 40 MB.

Please upload your tax exempt certificate here if applicable.

FEIN

Shipping Information

Shipping Address (If different from Billing Address)

Shipping/Additional Contact

Shipping/Additional Phone

Shipping/Additional Email

I have been working with:

Please select the DRI Employee you have been in contact with and sent you the form.

Signature*

Application for Open Account