This Credit Information request is a blank form. This document in its draft form contains
numerous of the standard clauses commonly used in these types of agreements, as
well as optional language to allow for customization to ensure the specific terms of the
parties’ agreement are addressed. This is a form used to check the credit references
when a customer wants to establish a credit account with a company. Use this form to
check the credit references of a customer trying to establish an account a company.
CREDIT INFORMATION REQUEST
[On Your letter head]
Full Name: __________________
RE: Credit Information Request
The person or company mentioned below has applied to open an account with us and has
given your firm’s name as a credit reference.
We would appreciate it if you would supply the information requested below. Your response
will be held in strict confidence and we would gladly reciprocate upon your request.
Date account opened: _______________________
Pays in ___________________________ days
Credit Limit _______________________
Present balance _____________________
Payment history _____________________
Please return a copy of this completed form to:
Credit Information Request 2
I _________________________________, of ________________________ hereby authorize
the release of financial information regarding my account.
Credit Information Request 3