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Date
___________________________________ Company Name
______________________________________
Bank Name ______________________________ Address
___________________________________________
Attention ______________________________ City __________________
State ____ Zip
____________
Fax Number: ____________________________ Account Number
____________________________________
AUTHORIZED SIGNATURE
__________________________________________
Name ___________________________________ Date
_________________
* NOTE: Banks now require
an authorized signature from their depositors for release
of information.
The above business has applied for open credit terms with our company and
listed your company as a credit reference. We would appreciate your response
on the following questions. All information provided will be strictly
confidential.
Date Account Opened
________________________________________________________________________
Current Balance
____________________________________________________________________________
Average Balance
____________________________________________________________________________
Present Loans ______________________________________________________________________________
Secured or Unsecured
_______________________________________________________________________
Loan experience satisfactory
_______________________________________________________________
Have there been any overdrafts?_____________________________________________________________
Comments____________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
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Credit information
released by
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_______________________________________
Signature
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______________________________
Title
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_______________________________________
Date
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