Attachment 11 Financial Information Questionnaire.docx

FA301621R0013

Contractor’s Name:

Contractor's Point of Contact:

Contractor's Financial Institution:

Financial Institution's Phone:

(To Be Completed by Financial Institution)

1. How long has the contractor had an account with your financial institution? ____________________

2. What is the contractor's current status with the financial institution? (e.g., poor, good, excellent) ___________________

Any additional comments? ______________________________________________________________

3. Has the company's accounting practices been satisfactory? ______________

If not, why? __________________________________________________________________________ ___________________________________________________________________________________

4. Indicate number and type of accounts the company have with the institution?

5. What is the company's current operational balance? (e.g., low, moderate, or high--five, six figure, etc.) __________________________

6. Does the contractor have a line of credit?____________________

If so, what is the limit (e.g., low, moderate, or high--five, six figure, etc.)? _______________________

Signature

Financial Institution Representative’s Title

Date