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DoormanRequest for Trade credit Reference

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or fill in details below and Submit this form



RE: Credit Reference for ,

Account # .

The above-named company has filed a credit application with our company naming your company as a credit reference.
By that application, the credit applicant has authorised us to contact the stated references and receive confidential
information from them regarding their credit history.
Attached please find a copy of the Credit Application naming your company as a reference and authorising our company to receive credit information.

We would, therefore, appreciate if you could provide us with the following information:

1. How long has the company had an account with your company?
2. What has been the average credit line of this company?
3. Is there a history of past due payments by this company?
4. What is current credit balance owed you by this company?
5. Has the repayment been satisfactory?
6. What are the credit terms that you have extended to
this customer?
7. Has this customer been a satisfactory customer?

We would appreciate any further information that you might be able to provide that may enable us to evaluate the credit
history of this applicant. All information will be held in strict confidence.

Thank you very much for your assistance.


Name of Signature

Phone (include country code and area code):


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