FINANCIAL QUESTIONNAIRE - Download as DOC

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					                               FINANCIAL QUESTIONNAIRE
                                             N69450-10-R-0768
                  (To be completed by Financial Institution and submitted by Offeror)
NAVFAC Southeast, Jacksonville, FL is currently considering award of a Navy contract to our firm. Prior
to award, the Navy requests 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. Upon completion of the questionnaire it is requested that you 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 May
18, 2010 at 3:00pm.

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: ______________________________________________________
Address: __________________________________________________________________________
Phone Number: _________________________________________________________
Account Number: __________________________________________
Type of Account: __________________________________________
Average Figure: ___________________________________________

Does the Contractor have a line of credit?    Yes          No

What is the limitation? _________________________ Unused balance: ______________________

What is the Contractor’s relationship with the bank:
   Outstanding        Satisfactory       Other (explain): ____________________________________

How long has the Contractor been a client? _______________________________

___________________________________________________________________
Signature and Title of person providing the above information

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, Page 1 of 1
                                                                                               (Rev 12/08)

				
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