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Back to Forms for 'Debtor and Creditor'.




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.





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