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Credit Application

Dear Valued Customer,

As part of the implementation of the U.S.Patriot Act, the U.S. Tresury Deparment has issued an interim final rule requiring "Dealers in precious metals, precious stones, jewels and covered goods" to implement an anti-money laundering program. 

Our company is operating in full compliance with the U.S. Patriot Act's Anti-Money Laundering Program. In order to fulfill our obligation in the instance of a FinCen(Financial Crimes Enforcement Network) audit, we need to have a record of pertinent business information on the companies whom we deal with. 

As such, we respectfully request that you complete the information on the accompanying form and return it to us either by mail or fax using the contact information on the bottom. Please be assured that all the information that you provide will remain completely confidential. 

As in the past, we will continue to conduct our business operations with the utmost integrity. We thank you in advance for your prompt attention to this matter and we look forward to continuing our business relationship. 

 

                   Usa studs inc                                             

 

 

                                                              Credit application

 

 

 

Phone:_________________________                                                               date:______________________

 

Firm name :____________________________________

 

Address:____________________________________________

 

City , State ,Zip :________________________________________________________________

 

Owner or officer:________________________________________________________________

 

Year at present address ____________________   years in business:________________________

 

 

 

Name ,Address and Phone Number of three principal suppliers.

 

1)____________________________________________________________________________

 

______________________________________________________________________________

 

______________________________________________________________________________

 

2)_____________________________________________________________________________

 

______________________________________________________________________________

 

______________________________________________________________________________

 

3)____________________________________________________________________________

 

______________________________________________________________________________

 

______________________________________________________________________________

 

 

 

Customer’s Signature

 

____________________________________________