Fillable Printable Bank Verification Form - Nevada
Fillable Printable Bank Verification Form - Nevada
Bank Verification Form - Nevada
Nevada State Contractors Board
Bank Verification Form Rev 11/11
Page 18 of 23
NEVADA STATE CONTRACTORS BOARD
9670 GATEWAY DRIVE, SUITE 100, RENO, NEVADA, 89521 (775) 688-1141 FAX (775) 688-1271, INVESTIGATIONS (775) 688-1150
2310 CORPORATE CIRCLE, SUITE 200, HENDERSON, NEVADA, 89074 (702) 486-1100 FAX (702) 486-1190, INVESTIGATIONS (702) 486-1110
www.nscb.nv.gov
BANK VERIFICATION FORM
Name of Licensee/Applicant: _________________________________________________________________
Date: __________________
Items 1 through 3 of the following report are to be completed by the applicant. Items 4 through 10 are to be completed by the
verifying bank. If the answer to any item is “none,” please indicate same in the appropriate space. After completion by you
and your bank, submit this form with your application.
1. Name and address of bank: ____________________________________________________
____________________________________________________
____________________________________________________
2. Signatures of account holder(s):
______________________________________ ___________________________________
Signature Print Name
__________________________________ ___________________________________
Signature Print Name
3. Information to be verified:
Type of Account Account Name Account Number
TO VERIFYING BANK: Please furnish the information requested below.
4. Classification of Account: Individual Corporation Partnership
Limited Partnership Limited Liability Company
5. Deposit accounts of applicants:
*Account Name Type *Account Number *Current Balance *Six (6) Month
Average
*Date Opened
*Required Information
6. Verification of Lines of Credit:
Line of Credit
Account #
Type of
Credit Line
Approved
Amount
Current
Balance
Available
Amount
Payments Required Secured by
$ Per
$ Per
$ Per
7. Additional information that may be of assistance in determination of credit worthiness: (Please include information on
loans paid in full.)
______________________________________________________________________________________________________
______________________________________________________________________________________________________
8. Affix Bank Stamp or Business Card 9. Name and Title: 10: Date: ______________
of Bank Representative __________________________
__________________________
