APPLICATION FORMS

Hello, welcome to the Empire Casting House family. We are excited to work together and create beautiful things. To ensure that your transactions are completed successfully, please fill out the forms below completely and sign them, then send them as an email to [email protected].

APPLICATION FOR NEW ACCOUNT

The undersigned hereby agrees this Empire Casting House of New York™
account is due and payable to Empire Casting House of New York and that
this application serves as an agreement for the sale of goods and / or services.

BUSINESS PHONE

CONTACT E-MAIL:

NAME OF BUSINESS:

WEBSITE:

ADDRESS (MAILING):

CITY, STATE AND ZIP CODE:

ADDRESS (SHIPPING):

CITY, STATE AND ZIP CODE:

DO YOU OPERATE UNDER OTHER NAMES? IF SO, LIST NAMES & ADDRESSES:

NAME

CITY, STATE AND ZIP CODE:

NAME OF OWNER / PRINCIPLE(S):

TAX IDENTIFICATION NO:

PLEASE STATE IF YOU ARE A MEMBER OF A BUYING GROUP:

IS THIS COMPANY COMPLIANT WITH AML {ANTI-MONEY LAUNDERING} PURSUANT TO THE UNITED STATES PATRIOT ACT?

CHECK ONE: CHECK ONE: INDIVIDUAL (PROPRIETORSHIP) PARTNERSHIP CORPORATION

HAVE YOU EVER HAD AN ACCOUNT WITH US BEFORE?

NAME:

CITY, STATE AND ZIP CODE:

PLEASE GIVE NAMES & ADDRESSES OF LAST FOUR ACTIVE JEWELRY TRADE REFERENCES :

1. REFERENCES

NAME

PHONE

ACCOUNT NO:

ADDRESS:

CITY, STATE AND ZIP CODE:

2. REFERENCES

NAME

PHONE

ACCOUNT NO:

ADDRESS:

CITY, STATE AND ZIP CODE:

3. REFERENCES

NAME

PHONE

ACCOUNT NO:

ADDRESS:

CITY, STATE AND ZIP CODE:

4. REFERENCES

NAME

PHONE

ACCOUNT NO:

ADDRESS:

CITY, STATE AND ZIP CODE:

NAME OF BANK:

PHONE NO:

CITY, STATE AND ZIP CODE:

CHECKING ACCOUNT NO:

CREDIT CARD AUTHORIZATION

CARD TYPE

WRITE CARD TYPE

NAME & SURNAME

CARD NUMBER:

EXPIRATION DATE (MM/YY)

CVV CODE:

SIGNED BY

DATE:

TITLE:

5 + 1 =

The undersigned hereby makes this application to Empire Casting House of New York™ (Creditor), and applicant agrees that all amounts payable on or before the due dates as shown on each invoice will be paid, and if not paid on said date, are then delinquent. It is understood that Creditor may impose and charge a delinquency charge which is the lower 2% per month or the highest rate allowed by law. Additionally, undersigned shall be responsible for all collection cost and attorney fee’s in connection with any delinquent amounts. The laws of the state of New York shall be applicable to all suits arising under any agreement between the undersigned and the Creditor. In the event of litigation, venue shall be in New York. Certified mail will be sufficient notice to effectuate personal service over the defendant, and the defendant agrees to wave citation. Undersigned agrees Creditor may utilize outside reporting services to obtain information and may apply payments at Creditor’s discretion. Persons signing application certify all information is true and correct to the best of their knowledge and belief.

This credit application cannot be processed unless completed, signed and dated by owner or principle stockholder.

“Each party agrees that the electronic signatures of the parties included in this Agreement are intended to authenticate this writing and have the same force and effect as manual signatures. Electronic signature means any electronic sound, symbol or process attached to or logically associated with a record and executed and adopted by the party with the intent to sign such record, including facsimile or e-mail electronic signatures.”

PRINTABLE FORMS

Hello, we are excited to work with you. Creating an account at Empire Casting House consists of a few steps. If you have filled out the form above and sent it to us, you have already taken the first step. To activate your account, please fill out the forms below completely and send them with wet signatures to [email protected].

Here are the steps you need to follow:

a. Click on the button named “Patriot Act Form Fillable” and open it in a new tab.
b. Fill out the form in the browser.
c. After filling out the form, click the “download” icon in the upper right corner. Select the option “Include My Changes” and download.
d. Sign the downloaded form.
e. Scan the form and send it to us by email.

Then repeat these steps for the “02-Tax-Exemption-Fillable” and “03-Application-For-Credit-Fillable” forms.

You also need to directly download and manually fill out the file named “04-Credit Card Authorization Form.”

When we receive all of these forms complete and without anything missing at [email protected], our customer service department will contact you to share your account information.

01-Patriot-Act-Form-Fillable

02-Tax-Exemption-Fillable

03-Application-For-Credit-Fillable

04-Credit Card Authorization Form

We look forward to working together. Have a great day.