CREDIT APPLICATION

Please tell us about your business.

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1Business Information

2Trade References

3Policies

Dear Customer and 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 U.S. 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.

Yes, we have or will be instituting an AML Program.

No, we will not institute an AML program due to our status as an “exempt” retailer.

Business Name*

DBA (if Any)

Owner Name

Owner Phone Number

Owner Email

Contact name for accounting

Phone

Address line 1*

Address line 2

Suite and Building

City*

Country*

State/Province*

Postal Code*

Phone Number*

Fax

User Email*

Password*

Enter Password Confirm Password

Website

Tax Identification Number / CRA GST Number*

Resale Certificate Number*

Government license number

Valid Government issued ID*

Max. file size: 10 MB.

Upload Credit Card Image Front*

Accepted file types: jpg, gif, png, pdf, Max. file size: 20 MB.

Upload Credit Card Image Back*

Accepted file types: jpg, gif, png, pdf, Max. file size: 20 MB.

Trade Reference #1

Company Name*

Contact Person*

Phone Number*

Email*

Company Address

City

Country

State/Province

Postal Code

Trade Reference #2

Company Name*

Contact Person*

Phone Number*

Email*

Company Address

City

Country

State/Province

Postal Code

Trade Reference #3

Company Name*

Contact Person*

Phone Number*

Email*

Company Address

City

Country

State/Province

Postal Code

Trade Reference #4

Company Name*

Company Person*

Phone Number*

Email*

Company Address

City

Country

State/Province

Postal Code

This website is operated by PRIYA GROWN DIAMONDS. Throughout the site, the terms “we”, “us” and “our” refer to PRIYA GROWN DIAMONDS INC. PRIYA GROWN DIAMONDS INC offers this website, including all information, tools and services available from this site to you, the user, conditioned upon your acceptance of all terms, conditions, policies and notices stated here. Read more...

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Fax to: +1 (646) 370-6567