TO BE COMPLETED BY FINANCIAL INSTITUTION:

Your above listed customer would like to become a distributor for us, and have listed you as a reference.
Please provide the information requested below, and fax back to us at 423-775-0611.
Thank you for taking the time to help your customer and us.

1). How long have you done business with them? ______________________

2). What is their high account balance with your bank? __________________

3). What is their current account balance? ____________________________

4). Have they had any of their company checks returned due to NSF? _______

5). If yes, how much was it for? ____________________________________

6). Do they have more than one account with your bank? ___ How many? ____