Company:_____________________________________________________________
D.B.A.:_______________________________________________________________
Address:______________________________________________________________
City,
State, Zip:_________________________________________________________
Telephone:______________
Fax:________________ Email:_____________________
Federal
Tax I.D.#:_________________ Number of Years in Business:_____________
Name
of Person Filling this form:__________________ Title:_____________________
Social
Security # of person filling this form:____________________________________
Circle one: Corporation
Partnership
Sole Proprietorship
LLP LLC
Bank
Name:______________________
Bank Account Number:___________________
Bank
Officer:___________________________________________________________
References
(Please include telephone, contact person, and your account
number):
1._________________________________________________________________________
2._________________________________________________________________________
3._________________________________________________________________________
The undersigned has applied for credit with International
Diamond Services. and hereby authorizes the release of any
and all credit information which may be required to process
this credit application.
_____________________________________ ___________________________
Signature
Date
