LALI Jewels - New Customer Registration Form

YesNo

Primary Contact - Name*

First NameLast Name

Primary Contact - Title/Position*

Company name - Legal Business Name:*

Store name / DBA "Doing Business As":*

if operating under "company name", re-type

JBT ID #*

if you do not have a JBT # enter "0"

Company Website:*

please include http://www. - if no website list any social media page, full url.

Primary Store Phone #*

Area CodePhone Number

Primary Mobile Number*

Area CodePhone Number

Primary E-mail*

Confirmation Email

Billing Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Billing Contact*

First NameLast Name

Billing Phone #*

Area CodePhone Number

Billing E-mail*

Confirmation Emailexample@example.com

Shipping Address: (must complete, if same as "billing" please re-type for confirmation)*

Street Address

Street Address Line 2

CityState

Zip CodeCountry

I agree to pay "overnight" shipping fee of $30 per package.I agree to pay "2nd day" shipping fee of $20 per package and I understand orders may take longer to deliver at no fault to LALI.I need my orders shipped Internationally and agree to pay respective shipping fee which vary pending order value and location TBD.

Currently, how many physical stores do you operate:*

Enter # of physical retail locations only, DO NOT consider e-com.

Currently, how many e-sites do you own:*

Enter # of e-commerce sites only, DO NOT consider physical store.

CBG - Continental Buying Group.LJG - Leading Jewelers Guild.RJO - Retail Jewelers Organization.Not part of above buying groups OR waive benefits

Please list at least three trade references:*

list separately, one per line and include company name, contact name and phone # including area code

Who is your account representative?*

How or Where did you hear about LALI Jewels?*

Signature*

confirm details of form

Date:*

Date

CONSIGNOR: LALI JEWELRY INC, dba "LALI Jewels" dba "LALI", a New York corporation. Principal office location: 50 West 47th Street, Suite 1610, New York, New York 10036.

Yes, LALI Jewels has my consent to file UCC as necessary (Consignment may be offered)No, LALI Jewels does not have my consent (Consignment WILL NOT be available)

CONSIGNEE, FULL BUSINESS LEGAL NAME (must match corporation name)*

STATE OF FORMATION*

ORGANIZATION TYPE (CORP./LLC/ETC.)*

PRINCIPAL OFFICE LOCATION*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Weekly, fastest replenishment opportunityBi-weekly, Every two weeks on 14th and 28th of the MonthMonthly, before 10th day of the Month

With the sales report10 days after receiving the invoice

Agree, need up to the maximum of four (4) weeks to return goods back to LALI

Yes, LALI has the right to update consigned products pricing anytime, with notice

PLEASE CONFIRM, FULL BUSINESS LEGAL NAME*

Consignee Name*

First NameLast Name

Your Title*

Signature*

Date*

Date

MEMORANDUM DISCLOSURE:

Pricing subject to change without notice. LALI reserves its rights to modify any information without notice. The goods described and valued herein are delivered to you for examination and inspection only and are the property of LALI Jewelry Inc. and are subject to its order and shall be returned to LALI Jewelry Inc. upon demand.  Such merchandise, until returned to LALI Jewelry Inc. and actually received, are at your risk from all hazards.  NO RIGHT OR POWER IS GIVEN TO YOU TO SELL, "LAYAWAY", PLEDGE, HYPOTHECATE OR OTHERWISE DISPOSE OF THIS MERCHANDISE regardless of prior transactions.  A sale of this merchandise can only be effected, and title will pass, only if and when LALI Jewelry Inc. shall agree to such sale and a bill of sale has been delivered by LALI Jewelry Inc.  Consignee (i.e., you) warrants, represents and agrees that the goods herein delivered, shall not be removed from the unique tag supplied by consignor (i.e., LALI Jewelry Inc.) and/or attached by consignee and that the goods while attached to such tags are unique and identifiable, such goods shall not be commingled or intermingled with any other goods nor shall the proceeds of sale of consignor’s merchandise be commingled with other proceeds, but shall be held in a segregated account. Consignee warrants, represents and agrees that consignee has sufficient “self-risk” insurance in effect with a reputable insurer to cover the full value of the goods subject of this memorandum and any other obligations here under. It is further agreed and warranted by the consignee that consignor may make claim upon consignee’s insurer(s) and any of consignee’s policies for any loss here under. In any such claim, consignee and its officers, directors, stockholders and employees and anyone that may be subject to their control shall fully cooperate with consignor and/or its representatives and attorneys and perform all actions, execute all instruments, attend meetings, trials and hearings and testify at all proceedings when requested, without remuneration of any kind. Any insurance claim by consignee or under its policy(ies) wherefore described shall be settled and adjusted exclusively with and paid to the consignor to the extent of the consignor’s interest here under, which shall include all obligations here under and thereafter accruing interest, attorney’s fees, disbursements and consequential damages. Further, the proceeds of any claim(s) on the consignee’s insurance or upon the consignee’s insurer(s) is assigned to consignor to the extent of consignee’s full liability for all of its obligations under this memorandum. The consignor is hereby granted an irrevocable and first-priority security interest in the proceeds of sale of consignor’s merchandise and a security interest and lien on all the goods, credits, assets, receivables, inventory and fixtures of consignee or in which consignee has any interest of whatever kind and/or nature and this security interest is given to induce consignor to enter into this transaction and secure consignee’s obligations here under. Consignor may execute on behalf of consignee all instruments and/or terms and/or certificates necessary to perfect and/or file its security interest as may be required by the laws of any state and/or the Uniform Commercial Code, without notice to consignee. With respect to any litigation arising here under, the parties agree to the exclusive jurisdiction of the courts of New York State and that New York law shall exclusively apply. If the consignor is required to bring any action against consignee and/or its insurer(s), the consignee agrees to pay consignor an additional amount in and for consideration of attorney’s fees to be liquidated at 25% of the value of all the goods listed on this memorandum or the total reasonable value of consignor’s attorney’s fees, whichever is greater. Due to variances in gold weights, please note that there may be up to a 5% variance in the gold weight, which may not already be reflected on this memorandum. Due to variances in diamond weights, please note that there may be up to a 2% variance in the Diamond Carat weight, which may not already be reflected on this memorandum. Due to variances in gemstone weights, please note that there may be up to a 10% variance in the Gemstone Carat weight, which may not already be reflected on this memorandum. Pearl quantity counted as per first production sample.  This is only an approximate quantity, as pearls may vary slightly in size and the quantity adjust subject to the total length of the item. The diamonds herein reflected on this memorandum have been purchased from legitimate sources not involved in funding conflict and in compliance with the United Nations Resolutions.  LALI Jewelry Inc. guarantees that these diamonds are conflict free, based on personal knowledge and/or written guarantees provided by the supplier of these diamonds. LALI Jewelry Inc. certifies that the diamonds herein are natural, untreated diamonds unless otherwise stated. Many gemstones are routinely treated with heat, dyes, pressure and/or other processes to improve the color or clarity of the stone. These treatments may not be permanent, may cause the need for special care and/or may affect the value of the stone. Many enhancements are difficult to detect without sophisticated instruments. The gems herein reflected on this memorandum may have been so treated. LALI Jewelry Inc. hereby warrants that the irradiated gemstones (or jewelry containing irradiated gemstones) subject to this memorandum were initially imported and distributed in the U.S. in compliance with U.S. licensing regulations.

Consignment - Memorandum Disclosure. Please read in full.

INVOICE DISCLOSURE:

Pricing subject to change without notice. LALI reserves its rights to modify any information without notice. LALI accepts all major credit cards (4% processing fee may apply), Bank Wire Transfers and Checks, Payable to: "LALI JEWELS". Merchandise may not be returned without the written permission of LALI Jewelry Inc. All claims must be made within five (5) business days after receipt of goods or the return, if approved, will be subject to a 10% restocking fee. In the event LALI refers accounts for collection of amounts due, buyer agrees to pay the attorney’s fees and collection agency’s fees with interest and the costs of the court. Interest shall be calculated at 1.5% monthly and 18% annually. All outstanding balances in the accounts must be cleared and paid by December 31st of the current calendar year. Buyer grants LALI power of attorney to file a financing statement in the appropriate jurisdiction if account is not paid in full within 30 days past terms and LALI also reserves the right to put a lien on buyer’s business. Furthermore, a stockholder, director and/or officer of the corporation personally guarantees payment of the outstanding balance owed to LALI upon demand. Signing for delivery by any method constitutes acceptance of the terms of this invoice. Buyer agrees that venue and jurisdiction shall be New York County. Due to variances in gold weights, there may be up to a 5% variance in the gold weight. Due to variances in diamond weights, there may be up to a 2% variance in the Diamond Carat weight. Due to variances in gemstone weights, there may be up to a 10% variance in the Gemstone Carat weight. Gemstone, Diamond and Gold weight may not already be reflected on this invoice. Pearl quantity counted as per first production sample.  This is only an approximate quantity, as pearls may vary slightly in size and the quantity adjust subject to the total length of the item. The diamonds herein invoiced have been purchased from legitimate sources not involved in funding conflict and in compliance with the United Nations Resolutions.  LALI Jewelry Inc. guarantees that these diamonds are conflict-free, based on personal knowledge and/or written guarantees provided by the supplier of these diamonds. LALI certifies that the diamonds herein are natural, untreated diamonds unless otherwise stated. Many gemstones are routinely treated with heat, dyes, pressure and/or other processes to improve the color or clarity of the stone. These treatments may not be permanent, may cause the need for special care and/or may affect the value of the stone. Many enhancements are difficult to detect without sophisticated instruments. The gems being sold herein may have been so treated. LALI hereby warrants that the irradiated gemstones (or jewelry containing irradiated gemstones) subject to this invoice were initially imported and distributed in the U.S. in compliance with U.S. licensing regulations.

Asset/Invoice Disclosure. Please read in full.

I agree to the MEMORANDUM and INVOICE disclosures as noted above. SIGNED BY:*

Consignee Name*

First NameLast Name

Date*

Date

YES - we have or will be instituting an AML Program.NO - we will not institute an AML program due to our status as "exempt" retailer.

New Retailer Registration Form

CONSIGNMENT CONSENT FORM

MEMORANDUM & INVOICE DISCLOSURES

Anti-Money Laundering (AML)