Sect_J_-_J-L-04_Financial_Questionnaire.docx

SECTION J-L-04

FINANCIAL QUESTIONAIRE

ATTACHMENT J-L-04

FINANCIAL QUESTIONNAIRE

(To be submitted by Offeror)

NAVFAC Southwest, Yuma, Arizona is currently considering award of a Navy contract to our firm. Prior to award, the Navy requires submission of the financial information listed below with regard to our firm. In order to be responsive to the Navy’s needs it is requested that you complete this financial questionnaire with regard to our firm and 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 no later than ___________________________

Prospective Contractor for which information is being requested:

Name: ______________________________________________________________ Address: _____________________________________________________________ City/State/Zip: ________________________________________________________ Phone Number: _______________________________________________________ Point of Contact: ______________________________________________________ Signature of Prospective Contractor or Contractor Representative Requesting Financial Information

Name of Financial Institution: ______________________________________________________ Account Number: __________________________________________ Type of Account: __________________________________________

Average Figure: ___________________________________________

Does the Contractor have a line of credit? |_| Yes |_| No

What is the amount? ______________ Unused Balance: ______________________

What is the Contractor's relationship with the bank:

|_|Very Good |_| Other (explain): __________________________ How long has the Contractor been a customer? _______________________________

Signature and Title of Person providing the above information (Please print name) Telephone Number________________________