Form Requesting Credit Reference

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CREDIT REFERENCE REQUEST

Date:

To:[name & address of credit reference]

Re:[name of person seeking a credit reference]

Dear Madam/Sir:

The above referenced person has applied for credit with our
company and has listed you as a credit reference. To assist us
in making our credit decision, please provide us with the below
requested information:

High credit limit:

Present balance:

Payment history:

Number of payments more than 30 days late:

Length of time account open:

Other information that we should consider:

Any information received from you will be held confidential.
Enclosed for your convenience is a stamped return envelope.

Sincerely,


______________________
[title]

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