Att 23 Financial Questionnaire.pdf

Financial Questionnaire, Page 1 of 1 (FLETC- PRO Rev 0_06/16)

Please provide any additional comments that may help determine the business and financial reputation and integrity of the prospective contractor on a separate sheet.

FINANCIAL QUESTIONNAIRE

(To be completed by Financial Institution and submitted by Offeror)

The Department of Homeland Security (DHS), Federal Law Enforcement Training Centers (FLETC), is considering award of a contract to this firm. Prior to award, the FLETC requests the financial information listed below with regard to this firm. To be responsive to FLETC's needs, it is requested that you complete this financial questionnaire with regard to this firm and upon completion place the completed questionnaire in a sealed envelope showing the return address of the financial institution and forward it to the Offeror shown below. The requested information must be received by the contractor no later than _______________________

Prospective Contractor for which information is being requested:

Name:

Address:

Phone Number:

Point of Contact::

Signature of Prospective Contractor or Contractor Representative Requesting Financial Information

Name of Financial

Institution:

Address:

Phone Number:

Account Number:

Type of Account:

Average Balance Figure :

Does the Contractor have a line of credit? Yes No

What is the limitation?

Remaining Balance:

What is the Contractor’s relationship with the bank?

Outstanding Satisfactory Other (explain):

How long has the Contractor been a client?

Name and Title of person providing the above information:

Signature of person providing the above information