Credit Reference Request Template

[Your Company Name]
[Your Address]
[City, State, ZIP]
[Phone] | [Email]

Date: [Date]

To: [Reference Company Name]
[Reference Company Address]
[City, State, ZIP]
Attn: [Reference Contact Name/Department]

Subject: Credit Reference Request for [Customer/Applicant Name]

1. Request

We are evaluating a credit request from [Customer/Applicant Name] (the “Applicant”). The Applicant has listed your company as a trade reference. If permitted by your policies, please provide the credit information requested below.

2. Authorization (Attach if Needed)

The Applicant has authorized us to contact trade references for credit evaluation purposes.
☐ Authorization attached ☐ Authorization on file dated [Date] ☐ Please advise if you require a separate authorization form.

3. Reference Questions

Please provide information to the best of your knowledge:

3.1 How long have you done business with the Applicant? [Answer]
3.2 What are the Applicant’s current credit terms with you? ☐ COD ☐ Net 15 ☐ Net 30 ☐ Net 60 ☐ Other: []
3.3 Typical monthly purchase volume: ☐ <$1,000 ☐ $1,000–$5,000 ☐ $5,000–$25,000 ☐ $25,000+
3.4 Average outstanding balance: $[] (or range: [])
3.5 Payment performance: ☐ Always on time ☐ Usually on time ☐ Occasionally late ☐ Frequently late
3.6 Any NSF/returned payments? ☐ No ☐ Yes (details): []
3.7 Current status: ☐ Good standing ☐ Past due ☐ On hold ☐ Other: []
3.8 Your recommended credit limit (if any): $[]
3.9 Would you extend credit to the Applicant again? ☐ Yes ☐ No ☐ Not sure

4. Return Instructions

Please return this completed request by [Due Date] via:
☐ Email: [Email] ☐ Fax: [Fax] ☐ Mail: [Address] ☐ Other: [Method]

5. Confidentiality

Information provided will be used solely for credit evaluation and account management, subject to applicable law and our internal policies.

Signatures

Requested by: [Name]
Title/Role: [Title]
Company: [Your Company Name]
Date: [Date]
Signature: ___________________________

Completed by (Reference): [Name]
Title/Role: [Title]
Company: [Reference Company Name]
Date: [Date]
Signature: ___________________________