Northfield Electric Department Credit Reference

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NORTHFIELD ELECTRIC DEPARTMENT
CREDIT REFERENCE
NAME OF APPLICANT:____________________________________________DATE___________________
ADDRESS:________________________________________________________________________________
PLEASE SIGN BELOW TO AUTHORIZE YOUR CHOSEN CREDIT REFERENCE INSTITUTE TO
RELEASE YOUR CREDIT HISTORY TO NORTHFIELD ELECTRIC DEPARTMENT. THIS
INFORMATION WILL BE USED TO EVALUATE YOUR REQUEST FOR A WAIVER OF DEPOSIT.
_______________________________________________
DATE_____________________________
Signature of Applicant
FORWARD THIS CREDIT REFERENCE FORM TO ONE OF THE FOUR LISTINGS BELOW AFTER
YOU COMPLETE THE ABOVE INFORMATION.
UTILITY REFERENCE (ELECTRIC/GAS/TELEPHONE OR CABLE)
NAME OF UTILITY:________________________________________________________________________
NAME ACCOUNT UNDER:__________________________________________________________________
ACCOUNT NUMBER:________________________OUTSTANDING BALANCE: $____________________
THIS APPLICANT HAS BEEN A CUSTOMER WITH THIS UTILITY FROM ____________________ TO
__________________(MUST BE AT LEAST 2 YEARS) AND HAS MAINTAINED A GOOD CREDIT
RECORD* FOR THIS PERIOD.
*GOOD CREDIT CONFIRMS THAT THE CUSTOMER HAS RECEIVED NO MORE THAN ONE (1)
DISCONNECTION NOTICE WITHIN THE LAST YEAR AND NO DISCONNECTION OF SERVICE
WITHIN THE LAST TWO (2) YEARS.
SIGNATURE & TITLE
: ______________________________________________________________
OF PERSON
COMPLETING THIS FORM : ______________________________________________________________
BANK REFERENCE
ACCOUNT#_____________________________________________
NAME & ADDRESS OF BANK:______________________________________________________________
THIS APPLICANT HAS HAD AN ACTIVE CHECKING ACCOUNT IN THIS BANK FROM
________________TO________________(MUST BE AT LEAST 1 YEAR) AND HAS HAD NO ACCOUNT
THAT HAS BEEN OVERDRAWN WITHIN THE LAST YEAR.
SIGNATURE & TITLE
:___________________________________________________________
OF PERSON
:______________________________________________________
COMPLETING THIS FORM

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