Bank Reference | AAA Express

Bank Reference Form

Company Name*

Bank*

Branch Address*

Street Address City Province Postal Code

Date*

Transit Number*

Account Number*

Name*

Position in Bank*

ACCOUNT OPEN FOR*

TYPE*

SECURITY*

LOAN ACCOUNTS (IF APPLICABLE)

REPAYMENT HISTORY

CURRENT

As Agreed*

Up To Date*

DEPOSIT ACCOUNTS

Confidentiality Note

The information in this report is confidential and may not be disclosed to any person other than the Requesting Bank and the Requesting Client. Neither the Responding Bank nor the Requesting Bank, nor any of their employees, will be liable in connection with this report or the accuracy or completeness of this information. The Requesting Client indemnifies and saves harmless both Banks and their employees, and the Requesting Bank, if requesting the report for its own use, indemnifies and saves harmless the Responding Bank and its employees, from any liability incurred as a result of this report. Receipt of this information constitutes agreement to the above.

Authorized Officer*

Word Verification