Form RD 410-8
U.S. DEPARTMENT OF AGRICULTURE
FORM APPROVED
(Rev. 12-08)
Rural Development
OMB NO. 0575-0091
APPLICANT REFERENCE LETTER
(A Request for Credit Reference)
We are considering an application for a loan from the applicant
listed below. We would appreciate you giving us the benefit of
your knowledge and/or experience with the applicant's credit
history to enable us to better evaluate the application.
Please return the original of this form to the requesting office
address below. A postage paid envelope is enclosed.
NAME OF AGENCY AND ADDRESS OF REQUESTING OFFICE
DATE
SIGNATURE AND TITLE NAME
NAME AND ADDRESS OF APPLICANT
SIGNATURE OF APPLICANT
ALL INFORMATION PROVIDED WILL BE RELEASED TO APPLICANT AT APPLICANT'S REQUEST
INDICATE THE NUMBER OF YEARS YOU HAVE:
RELATIONSHIP WITH APPLICANT
KNOWN APPLICANT
DONE BUSINESS WITH
BUSINESS
CREDITOR
EMPLOYER
LANDLORD
APPLICANT
HIGHEST AMOUNT APPLICANT
YOUR SECURITY FOR DEBTS
AMOUNT APPLICANT
APPLICANT'S REPAYMENT SCHEDULE
NOW OWED BY APPLICANT
HAS OWED YOU
PRESENTLY OWES YOU
$
$
$
WEEK
MONTH
PER
IS APPLICANT CURRENT IN
IF NO, INDICATE AMOUNT
$
REPAYMENT TO YOU?
DELINQUENT
YES
NO
RATE APPLICANT'S PROMPTNESS IN MAKING PAYMENTS:
WOULD YOU EXTEND
FURTHER CREDIT TO
INDICATE NUMBER OF TIMES
30 DAYS
60 DAYS
90 DAYS
APPLICANT?
PAYMENTS WERE LATE IN THE
YES
NO
LAST 24 MONTHS.
USE THIS SPACE TO INCLUDE ANY COMMENTS YOU WISH TO MAKE CONCERNING YOUR CREDIT EXPERIENCE WITH APPLICANT
SIGNATURE (Your signature acknowledges receipt of
DATE
TITLE (If a business firm)
statement required by the Privacy Act of 1974)
According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and a person is not required to respond to, a collection of
information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 0575-0091. The time
required to complete this information collection is estimated to average 6 minutes per response, including the time for reviewing instructions, searching
existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information.
This certifies that the U.S. Department of Agriculture has complied with the applicable provisions of Title XI the "Right to Financial Privacy Act 1978".
Public Law 95-630 in seeking financial information regarding the above named applicant.
SEE ATTACHED PRIVACY ACT NOTICE
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