CREDIT REFERENCE FORM

FINANCIAL INSTITUTION INFORMATION	CLIENT INFORMATION
BANK NAME	CLIENT NAME
CONTACT NAME	ACCOUNT NO.
ADDRESS	ADDRESS
PHONE	PHONE
FAX	FAX
EMAIL	EMAIL
Please be advised that your financial institution has been named as a credit reference for the aforementioned client's credit application. The client has authorized a review of confidential information. Thank you for your assistance in providing the requested information, below.
REQUESTED INFORMATION
LENGTH OF TIME CLIENT HAS HELD ACCOUNT	AVERAGE DAILY BALANCE OF ACCOUNT
DOES THE CLIENT TEND TO HAVE OVERDRAFTS?	HAS THE CLIENT TAKEN OUT ANY LOANS?
LOAN INFORMATION please complete, if applicable
BALANCE ON SECURED LOANS	TERMS OF REPAYMENT
BALANCE ON UNSECURED LOANS	REPAYMENT SATISFACTORY?
OUTSTANDING BALANCE	IS THE CLIENT SATISFACTORY?

REQUESTING PARTY INFORMATION
COMPANY NAME	COMPANY
CONTACT	ADDRESS
PHONE
FAX	EMAIL

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