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DDC Online Trading Platform Application
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DDC Authorized Retailer
Applicant's Information
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Name
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First
Last
Mid Initial/s
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Home Address
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Apt #
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City
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State
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Zip Code
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Country
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Home Telephone
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Cell Phone
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Include Country Code if Outside US
Personal Email Address
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Date of Birth
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(MM/DD/YYYY)
Country of Citizenship
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Picture
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Company Information
Company Name
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Company Type
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Sole Proprietor
Street Address
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Suite #
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Zip Code
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Country
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(Include Country Code if Outside US)
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Company Telephone
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Fax Number
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Work Email Address
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Website
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Title/Position
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Ownership Percentage
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%
Other Shareholders
Name
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Title
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Ownership
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%
Name
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Title
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Ownership
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%
State of Incorporation/Business Certificate
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Federal Tax ID Number
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Experience in the Diamond, Jewelry, or Gemstone Business
What is the Nature of Your Business?
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Are you listed in JBT?
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No
If Yes:
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JBT Number
Are you or have you ever been member of a diamond club that is affiliated with the World Federation of Diamond Bourses?
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No
If Yes:
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Name of WFDB Diamond Bourse
Year of Admission
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Are you party to any pending arbitration or lawsuit?
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No
Have you any unpaid judgments or arbitration awards against you or your company?
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Have you ever filed a bankruptcy petition personally or on behalf of your company?
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Have you ever been arrested for, charged with, or convicted of a felony or a misdemeanor?
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(If yes, please include an explanation in the comment box below)
Please use the box below for any additional information or explanation.
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