Business Credit Reports

Company Information

Company Name

Tax Identification #

Address

City

State/Province

Zip/Postal Code

Country

Type of Business

In Business Since

Legal Form (Corporation, Partnership, or Proprietorship)

If Division/Subsidiary, Name of Parent Company

In Business Since

Contact Information

First Name

Last Name

Title

Phone

Company Principal Responsible for Business Transactions #1

Name

Title

Address

City

State

Zip

Phone

Company Principal Responsible for Business Transactions #2

Name

Title

Address

City

State

Zip

Phone

Bank References #1

Institution Name

Checking Account #

Address

City

State

Zip

Phone

Fax

Bank References #2

Institution Name

Savings Account #

Address

City

State

Zip

Phone

Fax

Bank References #3

Institution Name

Home Equity Loan

Loan Balance

Address

City

State

Zip

Phone

Fax

Trade References #1

Company Name

Contact Name

Address

City

State

Zip

Phone

Fax

Account Opened Since

Credit Limit

Current Balance

Trade References #2

Company Name

Contact Name

Address

City

State

Zip

Phone

Fax

Account Opened Since

Credit Limit

Current Balance

Trade References #3

Company Name

Contact Name

Address

City

State

Zip

Phone

Fax

Account Opened Since

Credit Limit

Current Balance

Financial Information

Company Total Assets

Company Total Liabilities

Annual Net Income

Have you or your officers or affiliates ever filed a petition in bankruptcy? (Yes/No)

Is your company subject to any litigation? (Yes/No)

If so, describe

Request

Requested Amount

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