Registration Application

Credit Application Form

Please complete this form to apply for a wholesale account. Fields marked with * are required.

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Business Information

Name of Business

Registered Legal Name (if different)

Owner

Years Established

Years in Current Location

Number of Employees

Type of Business

Legal Status of Organization

Billing Address

Shipping Address

Phone

Mobile

Fax

Website

Facebook

Instagram

Bank Reference

Bank Name

Account Number

Branch Address

Phone

Contact Person

Have you ever filed bankruptcy?

If yes, when?

Owners & Authorized Buyers

Please list up to three individuals authorized to act on your behalf

Authorized Person 1

Full Name

Designation

Phone Number

Email Address

Authorized Person 2

Full Name

Designation

Phone Number

Email Address

Authorized Person 3

Full Name

Designation

Phone Number

Email Address

Trade References

Please provide three industry related trade references

Trade Reference 1

Company Name

Street Address

City

Province/State

Country

Phone

Trade Reference 2

Company Name

Street Address

City

Province/State

Country

Phone

Trade Reference 3

Company Name

Street Address

City

Province/State

Country

Phone

Anti-Money Laundering Agreement

For transactions with Integrity Diamonds & Jewellery (its affiliates and other business units thereof), on behalf of , I/we hereby certify that our company has implemented an Anti-Money Laundering program and is in compliance with the regulations under the Proceeds of Crime (Money Laundering) and Terrorist Financing Act (PCMLTFA) and other applicable Canadian AML laws.

Compliance Officer First Name

Compliance Officer Last Name

Terms & Conditions

1. This credit application is for business purposes only.
2. Credit is granted at the discretion of Integrity Diamonds & Jewellery and may be adjusted or revoked at any time.
3. Upon credit approval, this application serves as a sales agreement.
4. Invoices are due within 30 days. Late payments may incur a service charge of 1.5% per month.
5. The laws of British Columbia govern this application.
6. In case of default and collection, the applicant agrees to pay reasonable legal fees.
7. Returns are accepted upon approval from Integrity Diamonds & Jewellery.
8. The applicant must operate from a business address and is responsible for any lost goods shipped to a residential address.
9. The applicant agrees to keep goods secure and will be liable for any losses due to insufficient security.
10. The applicant must carry insurance for the value of goods shipped and will be liable for losses without adequate coverage.

Personal Guarantee

By submitting this application, you certify that the information provided is accurate and complete. You authorize us to contact the trade references listed above and agree to comply with our business policies, including payment terms and order conditions. Failure to meet the agreed terms may result in the termination of your account.

First & Last Name

Designation

Date