Confidential Credit Application and Acknowledgement of Terms

Net 30 terms are available for customers who have been in business for 1 year or longer. To qualify, customers must maintain a satisfactory credit rating with the Jewelers Board of Trade (JBT) or positive credit evaluations must be received from all company vendor references.

1. Company Name:*

JBT Number:

Company Address:*

City:*

State:*

Zip code:*

Telephone Number:*

Fax Number:

Email Address:

2. Date Business Began:*

Years at Current Location:

3. Organizational Structure:

Sole Proprietorship

Partnership

Corporation

LLC

Non-Profit

4. Owners and Officer:

Name & Title:

Address:

Name & Title:

Address:

Contact Person:

Responsible for Accounts Payable:

Federal Tax I.D. Number:

State Resale Number:

Customer Code:*

(New customers: if you have not yet received your MMA Customer Code, please note "Account Pending")

Trade References (Active Only): Complete All Four

Please list vendors with whom you have established credit history, on net 30 or similar terms. All four trade references are required. MMA International will contact you if additional information is necessary; however; this may delay processing of your credit application.

Trade Reference 1

Account:*

Name:*

Address:*

City:*

State:*

Zip code:*

Telephone Number:*

Fax Number:*

Trade Reference 2

Account:*

Name:*

Address:*

City:*

State:*

Zip code:*

Telephone Number:*

Fax Number:*

Trade Reference 3

Account:*

Name:*

Address:*

City:*

State:*

Zip code:*

Telephone Number:*

Fax Number:*

Trade Reference 4

Account:*

Name:*

Address:*

City:*

State:*

Zip code:*

Telephone Number:*

Fax Number:*

How would you like to receive your statements:

By Mail

Paperless (By E-mail)

Please read this agreement before submitting:

I/We authorize our trade references to release the information requested regarding our account. Approval of this credit application and the terms of any credit extended are in MMA International’s sole discretion.

Accounts past due 30 days or more will be charged interest on the unpaid balance at the rate of 1.5% per month (18% per annum). In the event that this matter is referred to an attorney or to a collection agency to enforce collection of any indebtedness owed by the undersigned to MMA International, LLC., the undersigned agrees to pay all reasonable costs thereof including, but not limited to, collection fees and expenses and reasonable attorney fees.

This Agreement shall be governed by and constructed by and in accordance with the substantive laws of the State of Texas, and customer hereby consents to submit to the jurisdiction of the State of Texas for the purpose of enforcing said Agreement

Date:*

Signer:*

Title:*

We will process your credit application as quickly as possible. Please be advised that this process usually takes 6 to 8 weeks. Until the application is approved, you may purchase via C.O.D., credit card (VISA, MasterCard, Discover Card, or American Express), or you may prepay your order. Thank you!: