Credit Reference Request

[Your Address]

[Your Logo]

To: ________________________________

Re: [Subject]

Your firm has been given to us as a credit reference by the subject company. In order for us to provide your customer the best service possible on a new order they have placed with us, we would appreciate it if you would complete the information below and return the form to us at our [Fax Number] or mail it to us in the enclosed postage-paid envelope.

All information you give us will be held in strict confidence and used for credit purposes only, and we would be happy to reciprocate on request.

Sincerely:

________________________________

Credit Manager’s Name

________________________________

Credit Manager’s Title

_______________________________ Date of first sale

_______________________________ Date of last sale

_______________________________ Recent high credit

_______________________________ Amount now owing

_______________________________ Amount past due

_______________________________ How old

Terms of sale: _________________________________________________________ Pay history: ___________________________________________________________ _____________________________________________________________________ _____________________________________________________________________