ATTACHMENT__7_Financial_Institution_Reference_Sheet_W9124J-17-R-0006_4_Jan_2017.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: POC Email:

I give permission for the following information regarding my account/s at your institution to be released to the representatives of the U.S. Army Mission and Installation Contracting Command (MICC), JBSA Ft Sam Houston, Texas.

Name/Title Signature/Date

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.)

1. What type of account do they have with you? SAVINGS CHECKING

2. How many years have they been a member with this institution? ___________________

3. Do they have any current debt? ________________________________________________________________________________ __________________________________________________________________________________________________________________________________________________________________________________________________________________________

4. Do they have an available line of credit? If so, how many figures? High or low? __________________________________________

5. Have you ever encountered problems with this company?

6. Is there any reason not to award a contract to this company:

I Verify that the information provided above is current as of

Name/Title_

Signature/Date: