The Credit Applicant whose signature appears below has had
an account with this bank for _________ years.
The Average balance of this account during the past two years has been in the
range of $___________________________________________________________________
________________________________________________________________________________
Signature of Bank Officer Account No.
________________________________________________________________________________
Bank Officer (Please Print) Title
________________________________________________________________________________
Name of Bank
________________________________________________________________________________
Address City & State
_(_____)________________________________________________________________________
Telephone Number
________________________________________________________________________________
Signature of Credit Applicant
By signing this Credit Request, applicant authorizes Barrets to perform a credit
investigation
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