Request for Credit Interchange[1]

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REQUEST FOR CREDIT INTERCHANGE Date: ____________________ To: ______________________ ______________________ ______________________ Re: ______________________ The above account has recently applied to our firm for credit and listed you as a credit reference. So that we may have adequate information on which to issue credit, we request the benefit of your credit experience with the account by providing us the following information: High Credit: $_____________________________ Low Credit: $_____________________________ Terms: __________________________________ How long sold: ___________________________ Present balance owed: $____________________ Payment history: __________________________ Any other credit information you believe helpful may be noted on the reverse side and shall be held strictly confidential. We are always pleased to reciprocate. A stamped return envelope is enclosed for your convenience. ______________________________________ Signature

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