Cfa Credit Reference Form
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1CREDIT REFERENCE FORM
Credit Experience
Applicant(s) Name
:________________________________________________________________________________________________
1.
How long have you done business with applicant(s)?
_________ Years
2.
How does the applicant(s) pay your open credit account?
Excellent (always pays on a timely basis)
Average (periodically pays over 30 days late)
Below Average (routinely pays over 60 days late)
Poor (problem account or cash basis only)
New Customer
3.
Do you have any past due accounts with applicant(s)?
Yes
No
If yes, explain in Section 2 under Comments.
4.
Do you have a note receivable with applicant(s)?
Yes
No
If yes, explain in Section 2 under Comments.
5.
Have you ever charged off bad debt or written off finance charges on accounts with applicant(s)?
Yes
No
If yes, explain in Section 2 under Comments.
6.
Please complete the following:
HIGH CREDIT BALANCE
CURRENT BALANCE
FREQUENCY OF PAYMENT
PAYMENT HISTORY
7.
Is applicant(s) contingently liable to you on any other account or been a principal in any other entity with which you
have had negative experience?
Yes
No
If yes, explain in Section 2 under Comments.
Comments
Interest Rate Participation
Note Interest Rate (Required)
No Participation – Use CFA Rates
Buy-down CFA’s interest rate by
%
Mark-up CFA’s interest rate by ______%
Other Instructions: ____________________________________________________________________________________________________________
Special Terms Rate (Optional)
Special Terms Rate (Optional)
Special Terms Rate (Optional)
Buy-down CFA’s interest rate by
%
Buy-down CFA’s interest rate by
%
Buy-down CFA’s interest rate by
%
Other Instructions & Account Description:
Other Instructions & Account Description:
Other Instructions & Account Description:
___________________________________
___________________________________
_________________________________
Character Assessment and Loan Recommendation
I/we assessed this applicant’s character and management ability and find no negative aspects that would materially
impact this loan. I recommend approval as requested.
I/we do not recommend approval of the loan.
Association Name: _________________________________________ Address: _____________________________________
Certified Lender’s Signature: _____________________________________________________ Date: ___________________
Revised 08/07
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Parent category: Financial