FCP Diamonds Account Setup/Renewal Contract

FCP Diamonds Account Setup/Renewal Contract
Company Information

Section 1
Full Legal Business Name*
DBA (Trade Name)*
Entity Type*
EIN/SSN*
Company Physical Street Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Is this the same as your preferred mailing address?*

YesNo
Preferred Mailing Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Primary Contact Information

Section 2
Full Name*

First NameLast Name
Title*
Phone Number*
Please enter a valid phone number.
Would you like to opt in for text notifications for special deals and account details?*

YesNo
By selecting "Yes" you agree to receive recurring messages from FCP Diamonds, LLC, Reply STOP to Opt out. Reply HELP for help. Message frequency varies. Message and data rates may apply. Carriers are not liable for delayed or undelivered messages. No mobile information will be shared with third parties/affiliates for marketing/promotional purposes. All OPT-IN requests include text messaging originator opt-in data and consent; this information will not be shared with third parties.
Email Address*
example@example.com
AntiMoney Laundering (AML) Information

Section 3
Does your organization have an AntiMoney Laundering (AML) program?*

YesNo
Is your organization planning to implement, or currently in the process of developing, an Anti-Money Laundering (AML) program?

YesNo
Are you exempt or not legally required to have an AML compliance program?

YesNo
FCP Diamonds, LLC. is required to adhere to strict Anti-Money Laundering (AML) compliance regulations. In accordance with the USA PATRIOT Act, the Bank Secrecy Act, and other applicable laws, we are unable to conduct business with vendors who do not have an AML compliance program in place and are not exempt from AML requirements.

If you need assistance in establishing an AML compliance program, we recommend contacting AML Gurus. Dave Griffiths at AML Gurus offers affordable compliance solutions to help protect your business.
AML Officer Name*

First NameLast Name
AML Officer Title*
Does your organization import/export precious metals from outside the USA?*

YesNo
Please list the country and details of the transaction(s)*
ConflictFree and Responsible Sourcing Declaration

Section 4
By signing this form, the company declares the following. Please check each box to indicate your agreement and continue.*
Beneficial Ownership

Section 5
Provide the details of all principals/owners with more than 25% control of the company
How many owners each hold more than 25% control of the company?*
Owner 1*

First NameLast Name
Title*
Email*
example@example.com
Ownership Percentage*
Residential Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Owner 2*

First NameLast Name
Title*
Email*
example@example.com
Ownership Percentage*
Residential Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Owner 3*

First NameLast Name
Title*
Email*
example@example.com
Ownership Percentage*
Residential Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Owner 4*

First NameLast Name
Title*
Email*
example@example.com
Ownership Percentage*
Residential Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Owner 5*

First NameLast Name
Title*
Email*
example@example.com
Ownership Percentage*
Residential Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Industry Information

Section 6
What industry best describes your company?*
Provide a brief description of your company:*
Terms and Conditions

Section 7
Signatures

Section 8
Company Name*
Owner 1
Full Name*

First NameLast Name
Title*
Date Completed*

MonthDayYear
Date
Signature*

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Owner 2
Full Name*

First NameLast Name
Title*
Date Completed*

MonthDayYear
Date
Signature*

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Owner 3
Full Name*

First NameLast Name
Title*
Date Completed*

MonthDayYear
Date
Signature*

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Owner 4
Full Name*

First NameLast Name
Title*
Date Completed*

MonthDayYear
Date
Signature*

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Owner 5
Full Name*

First NameLast Name
Title*
Date Completed*

MonthDayYear
Date
Signature*

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FCP Diamonds Account Setup/Renewal Contract

Company Information

Primary Contact Information

AntiMoney Laundering (AML) Information

ConflictFree and Responsible Sourcing Declaration

Beneficial Ownership

Provide the details of all principals/owners with more than 25% control of the company

Industry Information

Terms and Conditions

Signatures

Owner 1

Owner 2

Owner 3

Owner 4

Owner 5