Fillable Printable Credit Reference Request Form
Fillable Printable Credit Reference Request Form
Credit Reference Request Form
Credit Reference Request
(Your Address Here)
(Your Logo Here)
TO:
RE:
Your firm has been given to us as a credit reference by the subject company. In order for us to
provide your customer the best service possible on a new order they have placed with us, we would
appreciate it if you would complete the information below and return the form to us at our FAX #
<Your Fax Number> or mail it to us in the enclosed postage-paid envelope.
All information you give us will be held in strict confidence and used for credit purposes
only, and we would be happy to reciprocate on request.
Sincerely:
<Credit Manager’s Name and Title>
DATE OF FIRST SALE ______________ DATE OF LAST SALE _______________
RECENT HIGH CREDIT ______________ AMOUNT NOW OWING _____________
AMOUNT PAST DUE ________________ HOW OLD? _______________________
TERMS OF SALE __________________ PAY HISTORY _____________________
IS ACCOUNT SECURED? (YES/NO): HOW? ___________________________
COMMENTS
