Att6_Financial_Institution_Reference_Sheet__FMO.pdf

“Source Selection Information -- See FAR 2.101 and 3.104 – FOR OFFICIAL USE ONLY”

“Source Selection Information -- See FAR 2.101 and 3.104 – FOR OFFICIAL USE ONLY”

Attachment 6

FINANCIAL INSTITUTION REFERENCE SHEET (FA465918R0003)

Instructions to Contractor: Forward this 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 to exercise the option year of this contract.

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 319the Contracting Flight, Grand Forks AFB, and North Dakota.

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 or NSF’s:

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

Fax or Email Reference Sheet to Mr. Ja’Haun Stafford, jahaun.stafford.2@us.af.mil Contract Specialist Fax: 701-747-4215 mailto:jahaun.stafford.2@us.af.mil