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DITEC International

Thank you for your interest in DITEC products. Please note that the filing of this Application does not obligate the applicant to receive or DITEC to provide any agreement or contract. (Complete in Full and do not use abbreviations ).

Application form

I understand that any information I receive from DITEC International Corp. or from any employee, agent of DITEC is highly confidential ("Confidential Information"), has been developed with a great deal of effort and expense, and is being made available to me solely because of this application.

I agree that I shall treat and maintain all Confidential Information as confidential, and I shall not, at any time, without the express written consent of the board of directors of DITEC International Corp., disclose, publish, or divulge any Confidential Information to any person, firm, corporation or other entity, or use any Confidential Information, directly or indirectly, for my own benefit or the benefit of any person, firm, corporation or other entity, other than for the benefit of DITEC International Corp.

I authorize the procurement of an investigative consumer report and a background search in accordance with anti-terrorism legislation, such as the USA Patriot Act and Executive Order 13224 enacted by the US Government. I understand that this investigation may reveal information about my background, character, general reputation, mode of living, association with other individuals or entities, creditworthiness and job performance. I understand that, upon written request, within a reasonable period of time, I am entitled to additional information concerning the nature and scope of this investigation.

I hereby release a representative of DITEC, a credit bureau, security consultant or other investigative service provider selected by DITEC International Corp., its officers, agents, employees, and/or servants from any liability arising from the preparation of the investigative consumer report and/or background.



*(denotes required field)
Personal Information

Contact Information

Additional Information

Educational Background

BUSINESS INFORMATION (all spaces below must be completed)

REFERENCES (excluding relatives)

PERSONAL INFORMATION (please list figures in U.S. Dollars)

SPECIFIC DATA (please list figures in U.S. Dollars)

If names are to be included on the Agreements, please have these individuals fill out a separate application.