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Page 1/1 CreditRef Ver. 2005 Credit Reference Request □ Urgent, Order Pending Request Date: _________________ □ 1st Request □ 2nd Request □ 3rd Request To: _____________________________ Re: ________________________________ Co: _____________________________ Acct#: ______________________________ Address: _________________________ Address: ____________________________ ________________________________ ____________________________________ Tel: _____________________________ Tel: ________________________________ Fax: ____________________________ Fax: _______________________________ We are in the process of updating our credit file on the above referenced company. We ask you in confidence to assist us with the following information: Sales Activity Since: _______________ Terms of Sales: ______________________ Date of Last Sale: __________________ Credit Limit: _________________________ Highest Balance: ___________________NSF Activity: □Yes □No Open Balance: ____________________ If Yes how many times: ________________ Over All Rating: □ Good □ Fair □ Poor Payment History: □ Prompt □ Slow Average days to pay: _______________ Please provide any comments on your experience with this customer that would be helpful to us in determining the terms of credit to extend to applicant: _______________________________________________________________________________ _______________________________________________________________________________ Products Customer are purchasing? _________________________________________________ Reference given by: _______________________________ ____________________________________ Signature Position / Title _______________________________ ____________________________________ Print Name Date Completed ► Please fax it to: 510-252-9399 Attn: Credit Department Thank you very much for your assistance. Sincerely, Credit Department iGoLogic, Inc. iGoLogic, Inc. 46723 Fremont Blvd. Fremont, 94538 Tel: 510-252-9388 Fax: 510-252-9399 www.igologic.com
