We the undersigned, hereby apply with full responsibility for the opening of a new account with Transmed. We confirm that the information shown above is accurate. We authorize Transmed to verify any information from any sources deemed necessary. We acknowledge and agree that this application will be deemed an acceptance of Transmed sales terms and conditions as they appear on Transmed invoices. Any changes in the above information will be immediately communicated to Transmed otherwise we will remain fully responsible based on the information shared in this application under any circumstances and despite any changes.