Attachment_J-3_Financial_Questionnaire.pdf

Attachment J-3: Financial Questionnaire

Washington Headquarters Services, Acquisition Directorate is currently considering award of a contract to our firm. Prior to award, the Government requests the financial information listed below. In order to be responsive to the Government’s needs, it is requested that you complete this financial questionnaire with regard to our firm. Upon completion, place the completed questionnaire in a sealed envelope showing the return address of the financial institution and forward it to the Offeror’s address shown below. The requested information must be received by the Offeror no later than ____________.

Section 1: (To be completed by Offeror Requesting Financial Information)

Prospective Offeror for which information is being requested:

Company: __________________________________________________________

Address: ____________________________________________________________

Phone Number: ______________________________________________________

Point of Contact: ______________________________________________________ Name Title

Signature Date

Section 2: (To be completed by Financial Institution)

Name of Financial Institution: ___________________________________________

Address: ___________________________________________________________

Phone Number: ______________________________________________________

Account Number: ____________________________________________________

Type of Account: _____________________________________________________

Average Balance: ____________________________________________________

Does the Offeror have a line of credit? Yes No

If yes, what is the limitation? _____________________ Unused Balance: ___________________

What is the Offeror’s relationship with the bank?

Outstanding Satisfactory Other (explain): _________________________________

How long has the Offeror been a client? ___________________________________________

Name of Representative providing the above information:

Print Name Title

Signature Date