MOSHE ZWIEBEL DIAMOND CORP.   

30 West 47th Street New York,N.Y. 10036 Tel: (212) 719-3699
Fax: (212) 719-3735    
Credit Application    

                                                                                                                                                                     
Company Name:       Contact: 
Company Address:
                         City:      State:      Zip:
              Telephone:    Fax:   E-Mail:
                      JBT #:   Polygon:    AGS Member?
Years in business?:                     Years at current address? 
Best time to reach you?:     How did you hear about us?: 
Bank Name:        Account#: 
Telephone:          Contact:    

Trade References
1) Company Name : 
Company Address: 
City:    State:  Zip:
Contact: 
Tel:    Fax: 
___________________________________________
2) Company Name: 
Company Address: 
City:    State:  Zip:
Contact: 
Tel:    Fax: 
___________________________________________
3) Company Name: 
Company Address: 
City:    State:  Zip:
Contact: 
Tel:    Fax: 

                                                                                       back