Fire_Financial_Institution_Reference_Sheet.pdf
PDF 15 KB Posted
- Attached to
- Fire Protection And Emergency Services
- Solicitation number
- FA4659-15-R-0016
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Text version
FA4659-15-R-0016
FINANCIAL INSTITUTION REFERENCE SHEET
Instructions to Offerors: Please fill out and return a reference sheet for each financial institution that you have a business account with. This sheet may be sent to the banking institution/s in regards to a determination of contractor responsibility as part of the evaluation of offers for contract award.
TO BE FILLED OUT BY CONTRACTOR:
Company’s Name: ___________________________________________ Point of Contact (POC) Name: _________________________________ POC Phone Number: _________________________________________
INSTITUTION NAME: ______________________________________
POC Name: ________________________________________________ POC Title: _________________________________________________ POC Phone Number: _______________Fax Number: ______________
I give permission for the following information regarding my account(s) at your institution to be released to representatives of the 319th Contracting Flight, Grand Forks AFB ND.
Printed Name/Title Signature/Date
TO BE FILLED OUT BY FINANCIAL INSTITUTION:
Please give amounts as a range – i.e., low four figures, mid six figures, etc.
Average monthly balance in checking: ____________________________ Average monthly balance in savings: _____________________________ Amount of any current loans: ___________________________________ Amount of any lines of credit: __________________________________ Any late payments of NSFs: ____________________________________ How long with this institution: __________________________________ Credit rating with this institution: ________________________________
I verify that the information provided above is current as of _____________________________
Name/Title Signature/Date
You may return this form to SSgt Justin Baker or Queen McCartney electronically at justin.baker.19@us.af.mil queen.mccartney@us.af.mil or by fax at 701-747-4215.
mailto:justin.baker.19@us.af.mil mailto:queen.mccartney@us.af.mil
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