Personal Information

Client Name

Passport No

Date of Birth

Address

Home Fax No

Home Phone No

Cellular Phone No

Email Address

Business Background

Company Name

Address (1)

Address (2)

Office Phone No

Cellular Phone No

Fax No

Email Address

EIN/TAX No

State of Incorporation

Beneficiaries

Name of Company

Name

Title

Passport No

Title and Authorized Signature

Date

The above-listed Authorized Signatory expressly promises, attests and warrants that he/she/it is duly authorized by all appropriate persons and/or entities to sign this form and all provide all information contained herein.


Beneficiary Name

Bank Name

Bank Address

Account Name

Credit Account Number

Further Credit Account No. (if applicable)

SWIFT Code

Bank ABA/Routing Number

IBAN (if applicable)

Bank Officer:

Bank Telephone:

Bank Fax Number:


GAURANTEE AMOUNT:

DEPOSIT AMOUNT:

EFFECTIVE DATE:

EXPIRATION DATE:


UNDERWRITING REQUEST FOR DOCUMENTS

  • ✓ Overview of indemnitor company operations
  • ✓ Historical CPA prepared year-end financial statements(prefer ably3yrs)
  • ✓ Latest internally prepared financial statements
  • ✓ Accounts receiv ableand accounts payableaging reports that coincide with latest internally prepared financial statements
  • ✓ If available latest back logand pipeline reports

CONDITIONS TO CLOSE

  • ✓ No judgments and/orIRS taxliens
  • ✓ Commitment letter/Term Sheet from Senior Lender
  • ✓ Acceptable analysis and approval by Consumer Choice Assurance,LTD unde rwriting team