Attachment 7 - Financial Information Questionnaire Form.docx

FINANCIAL INFORMATION

Contractor Name:

Type of Service: MRSA Sanitation Services

Contractor's Financial Institution:

Contractor's Point of Contact:

Financial Institution's Phone No and Email:

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, fair, good, excellent, outstanding) ___________________. Any additional comments? __________

3. Has the company's accounting practices been satisfactory? ________. If no, why? __________________________________________________________________________________________________________________________________________________________________________

4. How many accounts and what types of accounts does the company have with the institution? _______

a. _______________________________________________________

b. _______________________________________________________

c. _______________________________________________________

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? ________ Low, moderate, or high--five, six figure, etc.? _____________________

7. Based on the contractor's financial history, current status, and the magnitude of this project (six figure), how do you feel the contractor will be able to perform his financial obligation? ____________________________________________________________________________________

Signature

Title Date