EarStudsUSA Credit Application

Please fill out the form and submit it, or print it out and fax it back to us.

Credit Application
Personal Information
Last Name:
First Name:
Middle Initial:
E-Mail:
Home Address:
City:
State:
Zip Code:
Business Information
Full Legal Name of Business:
D/B/A:
Phone:
Tax ID #:
Business Address:
City:
State:
Zip Code:
Do you Own or Rent your business location?	Own Rent
When did you start your business?
Have you ever been involved in bankruptcy?	No Yes
Owner Information List all partners in your business.
Owner Name #1:
Title:
Home Address:
Phone:
Owner Name #2:
Title:
Home Address:
Phone:
Banking Information
Name of Bank #1:
Account Number:
Phone:
Name of Bank #2:
Account Number:
Phone:
Insurance Information
Do you carry jewelry block insurance?	Yes No
Insurance Company:
Contact Name:
Phone:
Do you have Federal Express Insurance?	Yes No
Credit References
Company Name #1:
Contact Name:
Phone
Company Name #2:
Contact Name:
Phone
Company Name #3:
Contact Name:
Phone
I certify that all information on this form is correct. I authorize R.D.I. to obtain necessary information from the appropriate agencies.
Applicant's Signature:
Title:
Date:
Please fill out completely, print, sign and mail original back to: EarStudsUSA 5580 LBJ Frwy, Suite 525 Dallas, Texas 75240, U.S.A.

If you have any questions, click on Contact Us for a list of ways to reach us.