Close ABOUT COLLECTIONS CATALOG REQUEST JEWELER LOCATOR REGISTER/LOGIN CONTACT (201) 244-1150 CONFIDENTIAL CREDIT APPLICATION Company Name * Trade Name (D/B/A) E-Mail* Phone* Fax Adress* City* State* Zip Code ID Number JBT Listed/Rated Ship To (if different) Name: E-Mail Phone Fax Adress City State Zip Salesman Type of Organization * Corporation Partnership Individual Owner Type of Business * Wholesaler Chain Flyer Manufacturer Department Store Independent Jeweler Name of Principal(s) or Owner(s) Name Of A/P Contact Title Name Of Contact Name Title Name Of Buyer Bank Reference NAME OF INSTITUTION* CITY/STATE* ACCOUNT* PHONE FAX* BANK OFFICER/CONTACT Trade Reference NAME CITY/STATE PHONE FAX PERSON TO CONTACT NAME CITY/STATE PHONE FAX PERSON TO CONTACT NAME CITY/STATE PHONE FAX PERSON TO CONTACT NAME CITY/STATE PHONE FAX PERSON TO CONTACT Resale Certificate#/Tax Exempt "YOU HAVE AUTHORIZATION TO VERIFY THE ABOVE INFORMATION VERBALLY OR IN WRITING GUARANTEE IN ORDER TO INDUCE MIDAS CHAIN INC. TO SEL MERCHANDEE AND EXTEND CREDIT TO YOUR COMPANY THE UNDERSIGNED PERSNOALLY GUARANTEES THE PROMPT PAYMENT OF ANY, AND ALL INDEBTNESS WHICH MAY INCURRED BY THE APPLICANT TO MIDAS CHAIN INC.AND THE EVENT OF ANY DEFAULT AT ANY TIME BY THE APPLICANT, MIDAS CHAIN INC. SHALL BE ENTITLED TO LOOK TO THE INDERSIGNED GUARANTOR (S) IMMEDIATELY FOR SUCH PAYMENT WITHOUT PRIOR DEMAND OR NOTICE IN THE EVENT THIS ACCOUNT MUST BE REFERRED TO AN ATTORNEY OR AGENCY FOR COLLECTION ANY INDEBTNESS OWED BY GUARANTOR OR THE APPLICANT TO MIDAS CHAIN INC. THE GUARANTOR AGREES TO PAY REASONABLE COSTS THEREOF INCLUDING COLLECTION FEES, REASONABLE ATTORNEY FEES, COURT AND EXCPENSES INDURRED IN CONNECTION THEREWITH" DATE* SIGNATURE* AML Form Dear Business Partner, I am writing to you to inquire whether you have instituted an anti-money laundering (AML) program in compliance with the USA Patriot Act, the US Bank Secrecy Act and other regulatory requirements. In order to complete our compliance obligation, we are required under our policy and program to acquire the following identifying information for all our business partners and customers. Please provide the following identifying information. You may complete this form and fax it to 201-244-1151 or scan and email it to carol@midaschain.com. COMPANY NAME OWNER NAME ADDRESS TELEPHONE FAX EMAIL TAX ID RESALE I confirm that the above details are true and correct. YES, We have or will be instituting an AML Program. NO, We will not institute an AML Program. SIGNATURE DATE PRINT NAME Your response to this inquiry is an important element in our compliance program. Your prompt response to this is greatly appreciated. Sincerely, Sam Samuel SEND MIDAS PRESS ADVERTISEMENT ABOUT RESOURCES COLLECTIONS CATALOG REQUEST JEWELER LOCATOR ACCOUNT LOGIN REQUEST ACCESS CONTACT ADDRESS: 151 VETERANS DRIVE NORTHVALE, NJ 07647 PHONE: (201) 244 – 1150 FAX: (201) 244 – 1151 EMAIL: sales@midaschain.com © MidasChain 2021. All Rights Reserved