Please complete and fax this form to (908)874-9958


20 Running Brook Cir. Flemington, NJ 08822 Tel: 908-237-0258 Fax: 908-237-0139

BANK CREDIT INQUIRY

BANK NAME: _______________________ ATTN: ___________________

BANK ADDRESS: ______________________________________________

PHONE: ____________________ FAX: ___________________

COMPANY NAME: ______________________________________________

CHECKING ACCOUNT #: ____________________________________

SAVINGS ACCOUNT #: _____________________________________

The undersigned certifies that the above information, given for credit purposes, is true and correct and authorizes all parties contacted to release all credit and financial information requested, including banking records.

NAME (PRINT): __________________________ TITLE: ___________________

SIGNATURE: ____________________________ DATE: ____________

***************************** FOR BANK USE ONLY *******************************

Dear Bank Officer:

Please provide the following information, mail or fax to the number above. We thank you in advance for your help!

	CHECKING	SAVINGS	OTHERS
Open Date
Avg. Balance
Current Balance
No. of NSFs
Account Rating

Credit line: ___yes___no Secured: ___yes___no Credit Limit: ________________

Open Date: ________ Current Balance: __________ Maturity Date: ___________

Comments: _________________________________________________________

Prepared by: _____________________________________ Date: ____________

Name (Print): _____________________________________ Title: ____________