World Diamond Source

In order for us to extend open terms to your company kindly complete the following form.

Company Name

Billing Address

City State

Zip Code

Shipping Address
(if different from above)

City State

Telephone

Fax

Corporation Sole Proprietor

FEIN#

S.S. #

Owner's Name(s)

Name of Individual(s) Permitted to Purchase Items

Three suppliers you are currently purchasing from on open account.

Supplier's Name Phone # Account # Terms

Name of Bank Phone # Account # Contact

Our terms of sale: The above information is given for the purpose of obtaining credit with World Diamond Source, Inc., and is warrented to be true. I authorize World Diamond Source, Inc., and/or any authorized credit agency to investigate the references listed above. I also authorize World Diamond Source, Inc., to investigate my/our credit though any source available, including other trade references not listed above and credit information bureaus. I authorize any credit reference or credit bureau to release any information regarding my credit to World Diamond Source, Inc. I agree that my/our account will be charged interest at 18% per annum on any balance remaining unpaid 30 days after invoicing by World Diamond Source, Inc., including reasonable attorney's fees. Jurisdiction for any legal action concerning this account shall be in Florida with venue in Broward County.