Form

Credit Application
Business Name*
Tax ID*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Website*
Primary E-mail*
Phone Number*

Area CodePhone Number
Owner's Name*
Fax

Area CodePhone Number
Secondary Contact Name

First NameLast Name
Role
Secondary Contact Email
Phone Number

Area CodePhone Number
Bookkeeper
Bookkeeper Contact Name*

First NameLast Name
Bookkeeper Email*
Bookkeeper Phone Number*

Area CodePhone Number
Billing Address
Billing Address same as Mailing Address?*

YesNo
Billing Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Type of Business*

IndividualPartnershipCorporationWholesaleRetailTrade Shop
Jewelry Trade References
Trade Reference #1*

First NameLast Name
Phone Number*

Area CodePhone Number
Address*
Trade Reference #2*

First NameLast Name
Phone Number*

Area CodePhone Number
Address*
Trade Reference #3

First NameLast Name
Phone Number

Area CodePhone Number
Address
Personal Guaranty
I,
guarantee the payment of all sums that (company name)
(hereafter called “The Company”) now or hereafter

owe Brooklyn Jewelers. Should The Company default in payment of any sums due and

payable to Brooklyn Jewelers. I agree to pay to Brooklyn Jewelers all such sums. I agree

that my liability under this guaranty shall not be affected
Signature of Guarantor*

Clear
Print Name*
Title*
Date*

MonthDayYear
Bank Information
Name of Bank*
Bank Contact*
Address*
Phone Number*

Area CodePhone Number
Account Number*
The undersigned expressly agrees to pay, if the account becomes delinquent, all costs of collection, including but not limited to, collection agency fees, court costs, and attorney fees in addition to the principal balance and a delinquent finance charge of 1.75% per month. The undersigned, who desires to do business with Brooklyn Jewelers, agrees that if a lawsuit is necessary to collect money owing Brooklyn Jewelers, the venue of the lawsuit will be the State of New York and that the state of New York will have jurisdiction over the subject matter and also over tall parties to the lawsuit. Before lawsuit is filed, Brooklyn Jewelers, through its attorney, agrees to notify the debtor by certified mail, return receipt requested. The undersigned expressly agrees that the above method of citation certified mail, return receipt, will be sufficient notice to effectuate service over the defendant. The defendant also agrees to waive citation. It is expressly understood by all parties that this agreement is to facilitate the legal process only in the event a lawsuit is necessary to satisfy any obligations to Brooklyn Jewelers.
Signed by:*

Clear
Print Name*
Title*
Date*

MonthDayYear
Patriot Act
Dear Brooklyn Jewelers,

I am writing to inform you that our company fully complies with its legal obligations under the USA PATRIOT ACT and BANK SECRECY ACT and any relevant regulatory requirements.
Our company,
has a fully compliant antimoney laundering program, addressing each of the required elements under the law. Our program satisfies all of our antimoney laundering obligations, and periodically reviewed to ensure it is operating as designed.

You are specifically authorized to use this letter for any communication you may be required to make in connection with your own compliance obligations.

Regards,
Signature*

Clear
Role*
Should be Empty:

Bookkeeper

Billing Address

Jewelry Trade References

Personal Guaranty

Bank Information

Patriot Act