...hereby makes application for membership in The Jewelers Board of Trade. (NAME OF BUSINESS) at No... City of...state of...

Transcription

1 95 Jefferson Boulevard Warwick, Rhode Island USA T F membership@jewelersboard.com (MONTH) (DATE) (YEAR) TO: The Board of Directors of :...hereby makes application for membership in. (NAME OF BUSINESS) We are/i am (circle one) engaged in the...business (BUSINESS TYPE) at No... City of...state of... Zip No...Country...and if elected to membership in your Board of Trade will comply with and be bound by all the requirements of your Bylaws and any amendments thereto and will in consideration of such election, promptly pay the dues as provided for in said Bylaws. Respectively,... (NAME OF BUSINESS) AUTHORIZED SIGNATURE... PRINT NAME/TITLE... Excerpts from Bylaws Regarding Membership

2 Communication Consent Form In connection with The Can-Spam Act of January 2003 regarding commercial communications through the use of and other electronic forms of communication such as faxes ( Electronic Mail ), the Federal Communications Commission has issued regulations that require (JBT) to obtain your written consent for you to receive JBT Electronic Mail in the future. Company/organization name(s) for which consent is being provided: Name of authorized signatory of company/organization: Name: Title: Fax number(s) for which consent is being provided: Address(es) for which consent is being provided: I understand that by providing the information above, on behalf of the company/organization specified above, I am authorized to and hereby consent for the company/organization to receive Electronic Mail sent by or on behalf of The Jewelers Board of Trade. Signature: Date: Please return completed form to JBT at membership@jewelersboard.com] or by fax to Jefferson Boulevard Warwick, RI T F (7/14/16)

3 Credit Card Billing Information (same as on your Credit Card statement) Corporate/Personal Name (as appears on Card): Cardholder Billing Address: City: State: Zip: Country: Phone Number: Fax Number: Order Information Company Name: Member #: Card Type: Visa MasterCard American Express Credit Card #: Authorization Code (3 digits on back of card/4 Digit American Express CID): Expiration Date: Total Amount US/Canada $995 International $1,220 Cardholder s Signature: Please FAX completed form to: (401) Agreement: Note any future billings for any JBT services will automatically be charged to card above if you initial below. Initial: I authorize to use this credit card to process all future orders/billings. Note: Order/bill will not be processed until we receive a valid signature. ACH Instructions Account#: ACH/Routing#: To Wire to JBT Bank of America 100 Westminster Street Providence, Rhode Island Account: ABT#: Swift Code: BOFAUS3N 95 Jefferson Boulevard, Warwick, RI USA T F accounting@jewelersboard.com (05/24/17)

4 THE JEWELERS BOARD OF TRADE 95 Jefferson Blvd. Warwick, RI Ph: Thank you for your interest in The Jewelers Board of Trade. The following is required for general listings purposes and membership consideration. Please use this form to provide the following: Company Name: D/B/A: Address: City: State: Zip: Telephone: Fax: Address: Web Address: Mailing Address: PRINCIPALS/OWNERS: NAME TITLE NAME TITLE Year Born Married Single Divorced Widowed Year Born Married Single Divorced Widowed NAME TITLE NAME TITLE Year Born Married Single Divorced Widowed Year Born Married Single Divorced Widowed Please submit the employment history of all the principals/owners listed above. Include the company name, city and state of previous employers as well as the length of time employed, stating beginning and ending year of employment. (e.g ) THIS BUSINESS WAS INCORPORATED IN THE STATE OF ON / /. THE BUSINESS WAS STARTED BY IN/ON AND OPERATES AS A: SOLE PROPRIETORSHIP CORPORATION PARTNERSHIP LLC LLP LP FEDERAL IDENTIFICATION # (FEIN) 9 DIGITS: CORP. REGISTRATION #:

5 WE: THE PREMISES IS IN A(AN): LOCATED IN: WE OPERATE: RENT LEASE OWN OCCUPY OF: A KIOSK THE PREMISES A STORE AN OFFICE A STUDIO SHOPPING CENTER ENCLOSED MALL STRIP CENTER JEWELRY CENTER IN A RESIDENCE MULTI-STORY OFFICE BLDG ON THE FLOOR CENTRAL BUSINESS AREA SUBURBAN BUSINESS AREA INDUSTRIAL AREA RURAL AREA RETAILER WHOLESALER SPECIAL ORDER MFG DIAMOND CUTTER REPAIRER MANUFACTURER DEPARTMENT STORE APPRAISER OTHER FINE GOLD JEWELRY DIAMOND JEWELRY SILVER JEWELRY LOOSE DIAMONDS/STONES FIXTURES WATCHES PEARL JEWELRY COSTUME JEWELRY CLOCKS CHINA/CRYSTAL GIFTS CZ JEWELRY WATCH BANDS/BATTERIES TOOLS/EQUIPMENT PACKAGING/DISPLAY ACCESSORIES OTHER SALES ARE MADE: ON PREMISES VIA INTERNET BY APPOINTMENT OTHER WATCH/JEWELRY REPAIRS ARE: DONE ON THE PREMISES SENT OUT BOTH RENT AMOUNT $ LEASE EXPIRATION DATE (MONTH & YEAR) INSURANCE CONSISTS OF: A JEWELERS BLOCK POLICY BURGLARY LIABILITY SELF INSURED INSURANCE CARRIER: ALARM SYSTEM ON THE PREMISES: YES NO SQUARE FOOTAGE: # OF EMPLOYEES: # OF ADDITIONAL BRANCHES: BRANCH ADDRESS: BRANCH ADDRESS: TERRITORY COVERS: NUMBER OF ACCOUNTS: TERMS OF SALE: SALES ARE MADE TO: PLEASE LIST AS MANY SUPPLIERS AS POSSIBLE (NAMES ARE HELD IN STRICT CONFIDENCE) COMPANY NAME COMPANY ADDRESS AND/OR PHONE NUMBER BANKING INFORMATION: BANK NAME: ACCOUNT #: SIGNATURE: TITLE: DATE: RETURN FORM TO: GENERAL LISTING : jbtinfo@jewelersboard.com MEMBERSHIP CONSIDERATION: membership@jewelersboard.com