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This Page Is For JBT Rated Jewelry Stores With Standing Locations Only


OPEN CREDIT APPLICATION

Type Business (Check One)    Individual - Incorporated - Partnership- Proprietorship - Partnership Business

Store Name________________________________
Business Street Address________________________________________________________
P.O. Box_______________________
City___________________________ State__________________Zip Code_____________
Business Phone______________________________________Fax #____________________________

1st. Reference: Name Of Reference__________________________________________________
Street Address _________________________________________________________________
P.O. Box_______________________________________________________________________
City___________________________ State__________________
Zip Code_____________
Business Phone_________________________________________ Fax #_________________________

2nd. Reference: Name Of Reference__________________________________________________
Street Address _________________________________________________________________
P.O. Box_______________________________________________________________________
City___________________________ State__________________
Zip Code_____________
Business Phone_________________________________________ Fax #________________________

3rd. Reference: Name Of Reference__________________________________________________
Street Address _________________________________________________________________
P.O. Box_______________________________________________________________________
City___________________________ State__________________
Zip Code_____________
Business Phone_________________________________________ Fax #________________________

4th. Reference: Name Of Reference__________________________________________________
Street Address _________________________________________________________________
P.O. Box_______________________________________________________________________
City___________________________ State__________________
Zip Code_____________
Business Phone_________________________________________ Fax #_______________________

Legally Responsible Person Or Officer______________________ Full Title_______________
I understand and agree with all above information:
Signed___________________________________________Date___/___/___

This Is A Fax Form Or Mail Form

 

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