Attachment 23 - Financial Questionnaire.pdf

Financial Questionnaire, Page 1 of 1 ( Rev )

Please provide any additional comments that may help determine the business and financial reputation and integrity of the prospective contractor on a separate sheet.

FINANCIAL QUESTIONNAIRE

(To be completed by Financial Institution and submitted by Offeror) considering award of a contract to this firm. Prior to award, the requests the financial information listed below with regard to this firm. be s requested that you complete this questionnaire with regard to this firm completion place the completed questionnaire in a sealed envelope showing the return address of the financial institution and forward it to the Offeror shown below. The requested information must be received by the contractor no later than _______________________

Prospective Contractor for which information is being requested:

Name:

Address:

Phone Number:

Point of Contact::

Signature of Prospective Contractor or Contractor Representative Requesting Financial Information

Name of Financial Institution:

Address:

Phone Number:

Account Number:

Type of Account:

Average Balance Figure :

Does the Contractor have a line of credit? Yes No

What is the limitation?

Remaining Balance:

s relationship with the bank?

Outstanding Satisfactory Other (explain):

How long has the Contractor been a client?

Name and Title of person providing the above information:

Signature of person providing the above information