Attachment L3-Financial Reference Worksheet.pdf

DRAFT

ATTACHMENT L3

FINANCIAL RESPONSIBILITY QUESTIONNAIRE

Request for Proposal: ____________________________

INSTITUTION: _______________________________________________

ADDRESS: __________________________________________________

SUBJECT: Financial Responsibility Questionnaire for _____________________________________________

1. How long have you been doing business with_________________________________? (Contractor’s Name)

2. Do they have any loans outstanding with your institution? If so, have they ever had any payment problems?

3. Do they have a line of credit with your institution? If so, what is the pre-approved balance?

4. What is the average revolving monthly balance in checking or savings account with your institution? This does not have to be exact, but we would like to know if it is in the 3, 4, 5, 6, etc. figure range.

5. Would you continue to do business with_________________________________________________?

____________________________in the future? (Contractor’s Name)

6. The above inquiries provide basic financial responsibility insight, but if you would like to add any further information that would help us determine positive / negative standing, please feel free to comment.

Completed By: ________________________________ Position: ________________________________________

Date: ___________________________ E-mail or Telephone: _______________________________

Signature: ____________________________