Melting Bar, LLC - New Customers

Please fill out our "New Client Registration Form" below or download the Registration in PDF format and emial or fax it back to us and one of our Representives will get back to you shortly.

PDF form download click here..

New Client Registration Form

Client Regitration Form

Requestor's Name: (your name)
Prospective Customer Full Legal Name:
Customer Contact Name: (If different from Requestor's Name)
Customer Street Address: (P.O. Box not acceptable address)
City:
State:
Country:
Telephone:
Email: (if applicable)
Web page: (if applicable)
Fax:
If Customer has a TAX ID indicate below:
If customer DOES NOT have a Tax ID, briefly state why:
Estimated dollar amount per shipment
Estimated number of shipments per month: (please choose one) 0-5 6-10 11+
Is prospective customer publicity traded: (if you choose "NO" you can skip next question) Yes No
Provide name of the exchange:
List officer names and titles:
Enter number of employees: (please choose one) 1-100 101-1000 1001-5000 5001+
Has customer been established more than 3 years: Yes No
If customer been established for LESS THAN 3 years, provide year established:
Is prospective customer regulated: (if "NO skip the next question) Yes No
Provide primary reporting regulator or supervisory body:
Is company type a Head Office, Holding Company or Subsidary? Head Office Holding Company Subsidary
If you answer Subsidary above, provide name of Head Office/Holding Company and address:
Do you accept material directly from mines?: Yes No
Do any of your materials originate from the DRC (Democratic Republic of the Congo) or an adjoining Country?: Yes No
Describe the source of metal for refining:
Banking Information - where are accounts held, address, telephone number, name of account officer:
List 3 trade references the Company names, Contact name and number:

Welcome New Customers

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Client Regitration Form