Welcome New Customers




Contact Us

Meltingbar, LLC
740 Sansom Street
Suite 202
Philadelphia, PA 19107
Office: 215.627.GOLD(4653)
Fax: 267-886-8014
info@meltingbar.com
Directions
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


In order to complete or compliance obligation, we are required under our policy to obtain the following identifying information for all of our business partners and customers. Please provide the following information:

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: