1.9_Financial_Reference_Sheet.docx

FINANCIAL INSTITUTION REFERENCE SHEET

Instructions to Contractor: Include with your proposal 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 for award of this solicitation.

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 7th Contracting Squadron, Dyess AFB, TX.

Name/Title Signature/Date

DO NOT HAVE THIS SECTION FILLED OUT. IF YOUR FIRM IS SELECTED AS THE POTENTIAL AWARDEE, THIS FORM WILL BE SENT TO YOUR BANKING INSTITUTION FOR COMPLETION.

TO BE FILLED OUT BY FINANCIAL INSTITUTION:

Please give amounts as a range – i.e. low four figures, mid six figures, etc.

I verify that the information provided above is current as of _ .

Name/Title Signature/Date